Mandelcorn Efrem D, Al-Falah Mohammed, Zhao Lei Di, Kertes Peter, Devenyi Robert, Lam Wai-Ching
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia.
Acta Ophthalmol. 2022 Feb;100(1):e297-e303. doi: 10.1111/aos.14873. Epub 2021 Apr 12.
To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA).
Design: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post-operation.
Although all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post-operation (2.72 and 1.58 mmHg, respectively).
Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery.
通过光学相干断层扫描（OCT）成像和最佳矫正视力（BCVA）测量，比较在玻璃体切割手术结束时，0.1%的局部用奈帕芬酸与玻璃体腔内注射曲安奈德（IVTA）以及不进行辅助治疗（NAT）对接受视网膜前膜（ERM）玻璃体切割术患者术后黄斑形态改善的效果。
设计：前瞻性随机临床试验。地点：多中心。80例计划接受特发性ERM玻璃体切割手术的患者被随机分为三组，分别在手术结束时接受IVTA（4mg/0.1cc）、术后1个月每日3次局部使用0.1%的奈帕芬酸钠或不进行辅助治疗（NAT）。在手术前、术后1个月和2个月测量光学相干断层扫描（OCT）成像、最佳矫正视力和眼压（IOP）。
尽管所有三组术后黄斑厚度均有所降低，但NAT组改善最为明显，术后2个月时减少了136.18±29.84μm。各时间点组间黄斑厚度差异无统计学意义，p = 0.158。NAT组的BCVA恢复也最佳，术后2个月提高了0.207 logMAR（10.35个字母）。组间BCVA差异无统计学意义，p = 0.606。三组间眼压差异有统计学意义，仅在术后1个月时p = 0.04。IVTA组在术后1个月和2个月时平均眼压升高幅度最大（分别为2.72和1.58 mmHg）。
我们的研究数据表明，在玻璃体切割术后ERM手术中使用局部用奈帕芬酸或IVTA并无优势。
