Sakarya University Training and Research Hospital, Department of Ophthalmology, Korucuk street, Korucuk, Adapazarı, 54290, Sakarya, Turkey.
Int Ophthalmol. 2024 Aug 5;44(1):340. doi: 10.1007/s10792-024-03258-8.
The purpose of this study was to evaluate the effectiveness and safety of an intravitreal dexamethasone (DEX) implant for the treatment of macular edema (ME) following pars plana vitrectomy (PPV) and removal of the primary epiretinal membrane (ERM) and to assess the impact of the integrity of the ellipsoid zone (EZ) and disorganization of the retinal inner layer (DRIL) grade on visual and anatomical outcomes.
Forty-two pseudophakic patients who developed ME following PPV and removal of the primary stage 2-3 ERM were included. Patients were divided into two groups when ME was diagnosed via spectral domain optic coherence tomography (SD-OCT). In the DEX group (n = 22), DEX was implanted for the treatment of ME. In the control group (n = 20), only observation was conducted, without any treatment. The best-corrected visual acuity (BCVA) and macular thickness (MT) of the two groups were compared at baseline and 1, 6, and 12 months after DEX implantation. The effects of OCT parameters such as EZ integrity and DRIL grade were also evaluated in terms of decreases in MT and increases in VA in the treatment of ME with DEX implantation. Intraocular pressure (IOP), number of DEX implantations and adverse effects were also recorded.
While a statistically significant increase in the mean BCVA was observed in the DEX group (p < 0.001 at months 1, 6, and 12, respectively), no such increase was detected in the control group (p = 0.169, p = 0.065, and p = 0.058 at months 1, 6 and 12, respectively) compared with the baseline. A statistically significant decrease in the mean MT was observed in the DEX group (p < 0.001 at months 1, 6, and 12); however, no significant difference was observed in the control group (p = 0.081, p = 0.065, and p = 0.054 at months 1, 6 and 12, respectively) compared with the baseline. Significant differences were found between the two groups in terms of the increase in BCVA (p < 0.01) and decrease in MT (p < 0.01) at all visits, with the outcomes being more favorable in the DEX group. A statistically significant relationship was found between the increase in VA and EZ integrity and DRIL grade in both groups. Ten patients (45.4%) received two injections of DEX during the follow-up. An increase in IOP was observed in five patients (22.7%) who were treated with topical antiglaucomatous drops. No significant side effects were observed.
DEX implantation was found to be effective and safe for the treatment of ME following PPV and primary ERM removal, although some eyes may require repeated injections to achieve visual and anatomical success. Additionally, a relationship was found between EZ integrity, DRIL grade and visual-anatomical outcomes.
本研究旨在评估玻璃体内注射地塞米松（DEX）植入物治疗经睫状体平坦部玻璃体切割术（PPV）联合原发性内界膜（ERM）切除术治疗黄斑水肿（ME）的有效性和安全性，并评估椭圆体带（EZ）完整性和视网膜内层紊乱（DRIL）分级对视觉和解剖结果的影响。
纳入 42 例经 PPV 联合原发性 2-3 级 ERM 切除术后发生 ME 的无晶状体患者。通过频域光学相干断层扫描（SD-OCT）诊断 ME 时，患者被分为两组。DEX 组（n=22）接受 DEX 治疗 ME，对照组（n=20）仅观察，不进行任何治疗。比较两组患者基线及 DEX 植入后 1、6 和 12 个月的最佳矫正视力（BCVA）和黄斑厚度（MT）。还评估了 OCT 参数，如 EZ 完整性和 DRIL 分级，对 DEX 植入治疗 ME 时 MT 降低和 VA 升高的影响。还记录了眼内压（IOP）、DEX 植入次数和不良反应。
DEX 组的平均 BCVA 有统计学意义的增加（分别在第 1、6 和 12 个月时 p<0.001），而对照组无明显增加（分别在第 1、6 和 12 个月时 p=0.169、p=0.065 和 p=0.058）。DEX 组的平均 MT 有统计学意义的降低（分别在第 1、6 和 12 个月时 p<0.001），而对照组无明显差异（分别在第 1、6 和 12 个月时 p=0.081、p=0.065 和 p=0.054）。两组间 BCVA 增加（p<0.01）和 MT 降低（p<0.01）的差异有统计学意义，DEX 组的结果更有利。两组 VA 增加与 EZ 完整性和 DRIL 分级均呈统计学相关。10 例（45.4%）患者在随访中接受了 2 次 DEX 注射。5 例（22.7%）患者因眼压升高接受局部降眼压治疗。未观察到明显的不良反应。
DEX 植入治疗 PPV 联合原发性 ERM 切除术后 ME 是有效和安全的，尽管一些患者可能需要重复注射才能获得视力和解剖学上的成功。此外，还发现 EZ 完整性、DRIL 分级与视觉解剖结果之间存在相关性。
