El-Khoury Sylvain, Abdelmassih Youssef, Ducournau Didier, Drimbea Andrei, Portmann Alexandre
SOS Retine Sud, 29 Boulevard de la Ferrage, 06400, Cannes, France.
Department of Paediatrics and Retina, Fondation Ophtalmologique Adolphe de Rothschild, 26 Rue Manin, Paris, France.
Int Ophthalmol. 2025 Aug 25;45(1):352. doi: 10.1007/s10792-025-03721-0.
The aim of this study was to evaluate the outcome and complications associated with pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in the treatment of macular edema of various etiologies.
This observational, multicenter, longitudinal, retrospective study, initiated by the Société Française de Chirurgie Rétino-Vitréene in 2022, involved 27 surgeons from all over France. Data were collected preoperatively and at multiple postoperative time periods up to two years. The etiologies of macular edema included epiretinal membrane (ERM), vitreomacular traction syndrome (VMT), diabetic macular edema (DME), retinal vein occlusion (RVO), and postsurgical cystoid macular edema (PCME).
A total of 876 patients were included in the study. Best-corrected visual acuity (BCVA) significantly improved from 0.44 ± 0.26logMAR preoperatively to 0.22 ± 0.33logMAR at 1-2 years postoperatively (p < 0.001). Central macular thickness decreased from 422 ± 97 μm preoperatively to 337 ± 67 μm at 1-2 years. Intraoperative complications included retinal tear or retinal detachment in 6.3% of cases and intravitreal hemorrhage in 0.6% of cases. Postoperative retinal detachment occurred in 3.2% of patients. Intravitreal injection preoperatively was associated with poorer BCVA outcomes in the follow-up (p < 0.001). Patients who attained the best BCVA postoperatively demonstrated a macular thickness ranging from 320 to 400 μm.
PPV with ILM peeling proved to be an effective treatment for macular edema across various etiologies. Interestingly, good visual acuity following ILM peeling appeared to be associated with a larger macular thickness compared to the normal population. Intravitreal injections of anti-VEGF or dexamethasone implant preoperatively seemed to limit visual recovery.
本研究旨在评估玻璃体后皮质切除术（PPV）联合内界膜（ILM）剥除术治疗各种病因引起的黄斑水肿的疗效及并发症。
这项由法国视网膜玻璃体外科学会于2022年发起的观察性、多中心、纵向、回顾性研究，纳入了来自法国各地的27名外科医生。在术前及术后长达两年的多个时间段收集数据。黄斑水肿的病因包括视网膜前膜（ERM）、玻璃体黄斑牵拉综合征（VMT）、糖尿病性黄斑水肿（DME）、视网膜静脉阻塞（RVO）以及术后黄斑囊样水肿（PCME）。
本研究共纳入876例患者。最佳矫正视力（BCVA）从术前的0.44±0.26logMAR显著提高至术后1 - 2年的0.22±0.33logMAR（p < 0.001）。中心黄斑厚度从术前的422±97μm降至术后1 - 2年的337±67μm。术中并发症包括6.3%的病例发生视网膜裂孔或视网膜脱离，0.6%的病例发生玻璃体内出血。术后3.2%的患者发生视网膜脱离。术前玻璃体腔内注射与随访中较差的BCVA结果相关（p < 0.001）。术后获得最佳BCVA的患者黄斑厚度范围为320至400μm。
PPV联合ILM剥除术被证明是治疗各种病因引起的黄斑水肿的有效方法。有趣的是，与正常人群相比，ILM剥除术后良好的视力似乎与更大的黄斑厚度相关。术前玻璃体腔内注射抗VEGF或地塞米松植入物似乎会限制视力恢复。
