de Oliveira Júnior Elder Ohara, Ahn Isabel, Fernandes Rodrigo Antonio Brant, Fernandes Arthur Gustavo
Ophthal - Hospital Especializado, São Paulo, SP, Brazil.
Department of Ophthalmology and Visual Sciences, Paulista Medical School, Federal University of São Paulo - UNIFESP, São Paulo, SP, Brazil.
Int J Retina Vitreous. 2025 Jan 10;11(1):4. doi: 10.1186/s40942-024-00626-5.
Clinically significant macular edema (CME) is the leading cause of visual loss after ophthalmologic surgery due to the release of inflammatory mediators promoted by the procedures. We aimed to evaluate the outcomes of intravitreal Ozurdex (700 µg dexamethasone) implants as a primary therapeutical option for post-surgical macular edema cases.
Patients with post-surgical macular edema diagnosed by optical coherence tomography (Cirrus SD-OCT) and treated with Ozudex were selected for the current study. Data was retrospectively collected from medical records from January 2020 to December 2022 and included sex, age, laterality, and timeline of treatment (i.e. implant alone or at the time of silicon oil removal in cases requiring vitreorretinal surgery). Complications associated with treatment were also noted as well as the need of further treatments. The structural analysis focused on measuring central macular thickness (CMT-average thickness within the 1 mm circle of the ETDRS) from the internal limiting membrane to the Bruch's membrane complex, as well as the average total macular thickness including parafoveal and perifoveal regions determined by the device (CAT). The functional evaluation was based on the best-corrected visual acuity (VA) measured in logMAR.
A total of 46 participants were included (56.2% males, mean age: 60.9 ± 11.2 years old). A statistically significant change was observed in the postoperative versus the preoperative period for all parameters (p < 0.05). The mean VA difference was - 0.17 ± 0.24; CMT was - 109.22 ± 124.85 and CAT was - 14.76 ± 58.95. We observed a significant effect of the moment of Ozurdex implantation on VA improvement, so that cases with implantation at the time of oil removal showed lower improvement than cases with implantation at a distinct timing (Coef. 0.19, 95%CI: 0.02 to 0.36, p = 0.027). Eleven cases (23.9%) required further treatment such as new Ozurdex implantation (8 cases) or surgery (3 cases). Only one case (2.17%) showed increased intraocular pressure and underwent glaucoma surgery.
Intravitreal Ozurdex implants significantly improved functional and structural aspects in post-surgical macular edema. The timing of implantation influenced VA improvement, with a distinct step approach showing better outcomes than at the time of oil removal.
具有临床意义的黄斑水肿（CME）是眼科手术后视力丧失的主要原因，这是由于手术过程中释放的炎症介质所致。我们旨在评估玻璃体内注射Ozurdex（700μg地塞米松）植入物作为手术后黄斑水肿病例的主要治疗选择的效果。
选择通过光学相干断层扫描（Cirrus SD-OCT）诊断并接受Ozudex治疗的手术后黄斑水肿患者进行本研究。回顾性收集2020年1月至2022年12月的病历数据，包括性别、年龄、患侧以及治疗时间线（即仅植入或在需要玻璃体视网膜手术的病例中在硅油取出时植入）。还记录了与治疗相关的并发症以及进一步治疗的需求。结构分析重点测量从内界膜到布鲁赫膜复合体的黄斑中心厚度（ETDRS 1mm圆内的平均厚度），以及由该设备确定的包括黄斑旁和黄斑周围区域的平均总黄斑厚度（CAT）。功能评估基于以logMAR测量的最佳矫正视力（VA）。
共纳入46名参与者（男性占56.2%，平均年龄：60.9±11.2岁）。所有参数在术后与术前相比均观察到有统计学意义的变化（p<0.05）。平均VA差异为-0.17±0.24；CMT为-109.22±124.85，CAT为-14.76±58.95。我们观察到Ozurdex植入时间对VA改善有显著影响，因此在硅油取出时植入的病例比在不同时间植入的病例改善程度更低（系数0.19, 95%CI：0.02至0.36，p = 0.027）。11例（23.9%）需要进一步治疗，如再次植入Ozurdex（8例）或手术（3例）。仅1例（2.17%）出现眼压升高并接受了青光眼手术。
玻璃体内注射Ozurdex植入物显著改善了手术后黄斑水肿的功能和结构方面。植入时间影响VA改善，分步植入法显示出比在硅油取出时植入更好的效果。
