硅油取出时玻璃体内注射地塞米松植入物治疗孔源性视网膜脱离修复术后持续性黄斑水肿
Intravitreal Dexamethasone Implant at the Time of Silicon Oil Removal to Treat Persistent Macular Edema after Rhegmatogenous Retinal Detachment Repair.
作者信息
Pignatelli Francesco, Nacucchi Annalisa, Niro Alfredo, Gigliola Samuele, Passidomo Fedele, Donghia Rossella, Addabbo Giuseppe
机构信息
Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, 74100 Taranto, Italy.
Unit of Research Methodology and Data Sciences for Population Health, "Salus in Apulia Study" National Institute of Gastroenterology "Saverio de Bellis" Research Hospital, Castellana Grotte, 70013 Bari, Italy.
出版信息
J Clin Med. 2023 Feb 20;12(4):1697. doi: 10.3390/jcm12041697.
BACKGROUND
An intravitreal dexamethasone implant (DEX-I) was found to be effective and safe for the treatment of cystoid macular edema (CME) after vitrectomy for rhegmatogenous retinal detachment (RRD) and in silicone oil (SO)-filled eyes. We aimed to investigate the efficacy and safety of DEX-I at the time of SO removal for the treatment of recalcitrant CME after successful RRD repair.
METHODS
A retrospective review of the medical records was performed on 24 consecutive patients (24 eyes) with recalcitrant CME after RRD repair who were treated with a single 0.7-mg DEX-I at the time of SO removal. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A regression model was performed to assess the relationship between BCVA and CMT at 6 months and independent variables.
RESULTS
In all 24 patients, CME occurred after RRD repair and remained despite topical therapy. The mean time of CME onset was 27.4 ± 7.7 days after vitrectomy. The mean time between vitrectomy and DEX-I was 106.8 ± 10.1 days. The mean CMT was significantly decreased from 429.6 ± 59.1 µm at baseline to 294 ± 46.4 µm at month 6 ( < 0.0001). The mean BCVA significantly improved from 0.99 ± 0.3 at baseline to 0.60 ± 0.3 at month 6 ( < 0.0001). An elevation of intraocular pressure was observed in one (4.1%) eye, which was medically managed. A univariate regression model revealed a relationship between month-6 BCVA after DEX-I and gender (β = -0.27; = 0.03) and macular status (β = -0.45; = 0.001) when RRD occurred. No relationship between month-6 CMT and independent variables was found.
CONCLUSIONS
DEX-I at the time of SO removal had an acceptable safety profile and achieved favorable outcomes in eyes affected by recalcitrant CME that occurred after RRD repair. RRD-related macular status is significantly associated with visual acuity after DEX-I.
背景
玻璃体内注射地塞米松植入物（DEX - I）被发现对于孔源性视网膜脱离（RRD）玻璃体切除术后以及硅油（SO）填充眼的黄斑囊样水肿（CME）治疗有效且安全。我们旨在研究RRD成功修复后，在取出SO时使用DEX - I治疗顽固性CME的疗效和安全性。
方法
对24例（24只眼）RRD修复术后患有顽固性CME的连续患者进行回顾性病历分析，这些患者在取出SO时接受了单次0.7毫克的DEX - I治疗。主要观察指标为最佳矫正视力（BCVA）和中心黄斑厚度（CMT）的变化。进行回归模型分析以评估6个月时BCVA与CMT之间的关系以及自变量。
结果
所有24例患者在RRD修复后均出现CME，尽管进行了局部治疗仍持续存在。CME开始的平均时间为玻璃体切除术后27.4±7.7天。玻璃体切除术与DEX - I之间的平均时间为106.8±10.1天。平均CMT从基线时的429.6±59.1微米显著降至第6个月时的294±46.4微米（<0.0001）。平均BCVA从基线时的0.99±0.3显著提高到第6个月时的0.60±0.3（<0.0001）。在一只眼（4.1%）中观察到眼压升高，通过药物治疗。单变量回归模型显示，DEX - I治疗后第6个月的BCVA与性别（β = -0.27；P = 0.03）以及RRD发生时的黄斑状态（β = -0.45；P = 0.001）之间存在关系。未发现第6个月时CMT与自变量之间的关系。
结论
在取出SO时使用DEX - I具有可接受的安全性，并且在RRD修复后受顽固性CME影响的眼中取得了良好的效果。RRD相关的黄斑状态与DEX - I治疗后的视力显著相关。
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