Pole Cameron, Chehaibou Ismael, Govetto Andrea, Garrity Sean, Schwartz Steven D, Hubschman Jean-Pierre
Retina Division, Stein Eye Institute, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095-7002, USA.
Ophthalmology Department, AP-HP, Hôpital Lariboisière, Université de Paris, 75010, Paris, France.
Int J Retina Vitreous. 2021 Jan 25;7(1):9. doi: 10.1186/s40942-020-00254-9.
To investigate risk factors, imaging characteristics, and treatment responses of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair.
Consecutive, retrospective case-control series of patients who underwent pars plana vitrectomy (PPV) and/or scleral buckling (SB) for RRD, with at least six months of follow-up. Clinical and surgical parameters of patients with and without CME (nCME), based on spectral-domain optical coherence tomography (OCT), were compared.
Of 99 eyes enrolled, 25 had CME while 74 had nCME. Patients with CME underwent greater numbers of surgeries (P < 0.0001). After adjusting for number of surgeries, macula-off RRD (P = 0.06), proliferative vitreoretinopathy (PVR) (P = 0.09), surgical approach (PPV and/or SB, P = 0.21), and tamponade type (P = 0.10) were not statistically significant, although they all achieved significance on univariate analysis (P = 0.001 or less). Intraoperative retinectomy (P = 0.009) and postoperative pseudophakia or aphakia (P = 0.008) were more frequent in the CME group, even after adjustment. Characteristics of cCME on OCT included diffuse distribution, confluent cysts, and absence of subretinal fluid or intraretinal hyperreflective foci. Macular thickness improved significantly with intravitreal triamcinolone (P = 0.016), but not with anti-vascular endothelial growth factor agents (P = 0.828) or dexamethasone implant (P = 0.125). After adjusting for number of surgeries and macular detachment, final visual acuities remained significantly lower in the CME vs nCME group (P = 0.012).
Risk factors of CME include complex retinal detachment repairs requiring multiple surgeries, and pseudophakic or aphakic lens status. Although this cCME was associated with poor therapeutic response, corticosteroids were the most effective studied treatments.
探讨孔源性视网膜脱离（RRD）修复术后黄斑囊样水肿（CME）的危险因素、影像学特征及治疗反应。
对因RRD接受玻璃体切割术（PPV）和/或巩膜扣带术（SB）且随访至少6个月的患者进行连续回顾性病例对照研究。基于频域光学相干断层扫描（OCT）比较有和无CME（nCME）患者的临床和手术参数。
纳入的99只眼中，25只发生CME，74只未发生CME。发生CME的患者接受手术的次数更多（P < 0.0001）。在调整手术次数后，黄斑脱离的RRD（P = 0.06）、增殖性玻璃体视网膜病变（PVR）（P = 0.09）、手术方式（PPV和/或SB，P = 0.21）及填充类型（P = 0.10）虽在单因素分析中均有统计学意义（P = 0.001或更低），但差异无统计学意义。即使在调整后，CME组术中视网膜切除术（P = 0.009）及术后人工晶状体植入或无晶状体眼（P = 0.008）仍更常见。OCT上CME的特征包括弥漫分布、囊肿融合，且无视网膜下液或视网膜内高反射灶。玻璃体内注射曲安奈德后黄斑厚度显著改善（P = 0.016），但抗血管内皮生长因子药物（P = 0.828）或地塞米松植入物治疗无效（P = 0.125）。在调整手术次数和黄斑脱离情况后，CME组最终视力仍显著低于nCME组（P = 0.012）。
CME的危险因素包括需要多次手术的复杂视网膜脱离修复术，以及人工晶状体眼或无晶状体眼状态。尽管这种CME治疗反应较差，但皮质类固醇是研究中最有效的治疗方法。
