Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
BMC Ophthalmol. 2023 Aug 9;23(1):352. doi: 10.1186/s12886-023-03093-y.
Patients with pre-existing macular edema (ME) due to diabetes and retinal vein occlusions (RVO) make up a growing population receiving cataract surgery. Surgery is associated with an increased risk of worsening existing ME due to post-surgical inflammation that can be further exacerbated by pre-existing diabetic retinopathy (DR) and retinal vein occlusion. This study aimed to examine the pre-operative use of intravitreal dexamethasone (DEX) implants in patients with ME undergoing cataract surgery.
A retrospective study was conducted at National Cheng Kung University Hospital in Taiwan involving 19 eyes of 16 patients with DME or ME associated with RVO. All participants received a DEX implant at baseline and underwent phacoemulsification within 3 months after its insertion. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central subfield thickness (CST) were evaluated.
DEX implants reduced the CST from baseline (357.8 μm) to pre-surgery (280.8 μm). This reduction below baseline continued to month 6 post-surgery (319.4 μm). From baseline (16.15 mmHg), the mean IOP initially increased pre-surgery (17.78 mmHg) before returning to the baseline value at month 6 post-surgery (16.15 mmHg). All patients improved their BCVA from logMAR 0.943 on average at baseline to logMAR 0.532 at month 6 post-surgery.
The results of the study suggested that patients with ME could benefit from DEX implants before cataract surgery within 3 months to achieve sufficient postoperative inflammation management and limit ME deterioration. DEX implants did not increase IOP post-surgery and was similar to baseline levels.
患有糖尿病性黄斑水肿（ME）和视网膜静脉阻塞（RVO）的患者不断增加，他们在接受白内障手术时存在潜在 ME 恶化的风险。这种风险可能因术后炎症而增加，而糖尿病视网膜病变（DR）和视网膜静脉阻塞等疾病也会进一步加剧这种风险。本研究旨在探讨 ME 患者在接受白内障手术前使用玻璃体内地塞米松（DEX）植入物的情况。
这是一项在台湾成大医院进行的回顾性研究，共纳入 16 名患者的 19 只眼，这些患者患有 DME 或与 RVO 相关的 ME。所有患者在基线时均接受 DEX 植入物治疗，并在植入后 3 个月内行超声乳化白内障吸除术。评估最佳矫正视力（BCVA）、眼压（IOP）和中央视网膜厚度（CST）。
DEX 植入物将 CST 从基线（357.8μm）降低至术前（280.8μm）。这种下降趋势在术后 6 个月（319.4μm）时仍持续低于基线水平。从基线（16.15mmHg）开始，IOP 先在术前（17.78mmHg）升高，然后在术后 6 个月（16.15mmHg）时恢复到基线水平。所有患者的 BCVA 均从基线时的平均 logMAR 0.943 提高至术后 6 个月时的 logMAR 0.532。
研究结果表明，ME 患者在白内障手术前 3 个月内接受 DEX 植入物治疗，可实现充分的术后炎症管理并限制 ME 恶化，从而获益。DEX 植入物不会增加术后眼压，与基线水平相似。
