曲安奈德对特发性黄斑前膜患者手术效果的影响

Effect of intravitreal triamcinolone acetonide on surgical efficacy of idiopathic epimacular membrane

目的研究玻璃体注射曲安奈德(intravitreal triamcinolone acetonide,IVTA)对特发性黄斑前膜(idiopathic anterior macular membrane,IMEM)术后黄斑区解剖结构与视功能的影响。设计病例对照研究。研究对象2017年1月至2019年12月于河北医科大学第二医院眼科接受手术治疗的IMEM患者74例(74眼)。方法采用随机数字表法将患者随机分为玻璃体切除术联合IVTA组(注药组,38例38眼)和单纯玻璃体切除术组(对照组,35例35眼)。两组患者行玻璃体切除术剥除黄斑前膜及内界膜,注药组术眼术中IVTA 2 mg/0.05 ml。术后随访至少12个月。观察两组患者手术前、术后1、3、6、12个月最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹厚度(macular fovea thickness,CMT)、异常中心凹内层(ectopic inner foveal layers,EIFL)+外丛状层厚度及眼压的变化情况,采用Pearson相关分析,多元线性回归方程,广义估计方程进行统计分析。主要指标BCVA、CMT、EIFL+外丛状层厚度。结果两组患者术前BCVA与EIFL+外丛状层厚度均密切相关(r=0.934,P=0.005)。注药组和对照组术后BCVA均较术前明显提高(χ^(2)=3428.83,P<0.001;χ^(2)=445.67,P<0.001);术后3、6、12个月,两组间BCVA差异有统计学意义(χ^(2)=8.31,P=0.004;χ^(2)=11.31,P=0.001;χ^(2)=22.54,P<0.001),注药组视力提高较对照组明显。注药组和对照组CMT术后均显著降低(χ^(2)=1121.82,P<0.001;χ^(2)=355.92,P<0.001);术后3、6、12个月,两组间CMT差异有统计学意义(χ^(2)=12.47,P<0.001;χ^(2)=21.15,P<0.001;χ^(2)=28.88,P<0.001),注药组患者术后CMT降低较对照组明显。注药组和对照组EIFL+外丛状层厚度术后显著降低(χ^(2)=842.68,P<0.001;χ^(2)=246.40,P<0.001)。术后3、6、12个月,两组间EIFL+外丛状层厚度差异有统计学意义(χ^(2)=11.25,P=0.001;χ^(2)=15.93,P<0.001;χ^(2)=11.98,P=0.001),注药组EIFL+外丛状层厚度降低较对照组明显。结论IMEM患者玻璃体手术术毕时IVTA有利于黄斑解剖结构和视功能的恢复。

Objective To observe and analyze the effect of intravitreal triamcinolone acetonide(IVTA)on the anatomical structure and visual function of the macular area after the operation of idiopathic anterior macular membrane(IMEM).Design Case-control study.Participants 74 patients(74 eyes)with IMEM underwent surgery in the Second Hospital of Hebei Medical University from January 2017 to December 2019.Methods The patients were randomly divided into vitrectomy combined with IVTA group(38 cases,38 eyes)and vitrectomy group(35 cases,35 eyes).Vitrectomy was performed to remove the epimacular membrane and internal limiting membrane in the two groups,and IVTA 2 mg/0.05 ml was performed in IVTA group.The patients were followed up for at least 12 months.The best corrected visual acuity(BCVA),macular fovea thickness(CMT),ectopic inner foveal layers(EIFL)+outer plexiform layer thickness and intraocular pressure(IOP)were observed before and 1,3,6 and 12 months after operation.Pearson correlation analysis,multiple linear regression equation and generalized estimation equation were used for statistical analysis.Main Outcome Measures BCVA,CMT,EIFL+outer plexiform layer thickness.Results The preoperative BCVA was closely related to the thickness of EIFL+outer plexiform layer(r=0.934,P=0.005).The BCVAs of IVTA group and the control group were significantly improved after operation(χ^(2)=3428.83,P<0.001;χ^(2)=445.67,P<0.001);At 3,6 and 12 months after operation,the difference of BCVA between the two groups was statistically significant(χ^(2)=8.31,P=0.004;χ^(2)=11.31,P=0.001;χ^(2)=22.54,P<0.001).The BCVA of the IVTA group was significantly better than that of the control group.The CMT of IVTA group and the control group were significantly decreased after surgery(χ^(2)=1121.82,P<0.001;χ^(2)=355.92,P<0.001).There was significant difference in CMT between the two groups at 3,6 and 12 months after operation(χ^(2)=12.47,P<0.001;χ^(2)=21.15,P<0.001;χ^(2)=28.88,P<0.001).The CMT in the IVTA group was significantly lower than that in the control group.The EIFL+outer plexiform layer thickness of IVTA group and the control group decreased significantly after operation(χ^(2)=842.68,P<0.001;χ^(2)=246.40,P<0.001).At 3,6 and 12 months after operation,there was significant difference in EIFL+outer plexiform layer thickness between the two groups(χ^(2)=11.25,P=0.001;χ^(2)=15.93,P<0.001;χ^(2)=11.98,P=0.001).The EIFL+outer plexiform layer thickness in the IVTA group was significantly lower than that in the control group.Conclusion IVTA at the end of surgery can assist in the recovery of macular anatomy and visual function after vitrectomy in patients with idiopathic epimacular membrane.