地塞米松玻璃体内植入剂在特发性黄斑前膜玻璃体手术中的应用

Application of dexamethasone intravitreal implant in vitrectomy of idiopathic macular epiretinal membrane

目的比较特发性黄斑前膜患者玻璃体手术联合与不联合玻璃体腔地塞米松玻璃体内植入剂注药术后视网膜黄斑区超微结构与视功能变化。方法收集2019年1月至2022年12月接受手术治疗的特发性黄斑前膜患者94例(94只眼)。按术毕时是否联合玻璃体腔内注射地塞米松玻璃体内植入剂将患者分为注药组59例(59只眼)和对照组35例(35只眼)。2组患者行玻璃体切除术剥除黄斑前膜及内界膜,术后随访>12个月。观察2组患者手术前后最佳矫正视力(BCVA)、黄斑中心凹厚度、异常中心凹内层厚度的变化情况。结果患者术前及术后1、3、6、12个月最佳矫正视力(LogMAR)分别为0.71±0.14、0.62±0.15、0.51±0.16、0.48±0.29、0.36±0.20,注药组和对照组术后最佳矫正视力LogMAR视力均较术前明显提高(Waldχ^(2)=3428.83,P<0.001;Waldχ^(2)=445.67,P<0.001)。在术后3、6、12个月,2组间最佳矫正视力差异有统计学意义(Waldχ^(2)=8.31,P=0.004;Waldχ^(2)=11.31,P=0.001;Waldχ^(2)=22.54,P<0.001)。黄斑中心凹视网膜厚度分别为(472.64±69.69)、(423.68±83.56)、(380.08±104.98)、(319.55±95.83)、(294.55±104.88)μm,差异有统计学意义(Waldχ^(2)=1322.92,P<0.001)。在术后3、6、12个月,2组间黄斑中心凹厚度差异有统计学意义(Waldχ^(2)=12.47,P<0.001;Waldχ^(2)=21.15,P<0.001;Waldχ^(2)=28.88,P<0.001)。异常中心凹内层厚度分别为(189.87±38.22)、(164.05±40.17)、(142.08±47.80)、(112.51±52.87)、(91.49±53.25)μm,差异有统计学意义(Waldχ^(2)=969.82,P<0.001)。在术后3、6、12个月,2组间异常中心凹内层厚度差异有统计学意义(Waldχ^(2)=11.25,P=0.001;Waldχ^(2)=15.93,P<0.001;Waldχ^(2)=11.98,P=0.001)。结论特发性黄斑前膜患者术毕时玻璃体腔注射地塞米松玻璃体内植入剂可以辅助于黄斑超微结构和视功能的恢复。

Objective To compare the changes in macular ultrastructure and visual function in patients with idiopathic macular epiretinal membrane after vitrectomy combined with intravitreal dexamethasone intravitreal implant injection or not.Methods From January 2019 to December 2022,94 patients(94 eyes)with idiopathic macular epiretinal membrane treated with vitrectomy were included.They were allocted to injection group(59 cases,59 eyes)and control group(35 cases,35 eyes).Patients in injection group were given intravitreal dexamethasone intravitreal implant injection at the end of vitrectomy.All patients underwent vitrectomy to remove epimacular membrane and inner limiting membrane.Postoperative follow-up was conducted for at least 12 months.Changes in the best corrected visual acuity(BCVA),fovea thickness and thickness of ectopic inner foveal layers before and after surgery were compared.The generalized estimation equation was used for statistical analysis.Results The BCVA(LogMAR)before and 1,3,6 and 12 months after surgery was 0.71±0.14,0.62±0.15,0.51±0.16,0.48±0.29 and 0.36±0.20,respectively.Postoperative BCVA in injection group and control group was significantly improved than the preoperative level(Waldχ^(2)=3428.83,P<0.001;Waldχ^(2)=445.67,P<0.001).At 3,6 and 12 months postoperatively,the enhancement of BCVA in the injection group was significantly pronounced than that in the control group(Waldχ^(2)=8.31,P=0.004;Waldχ^(2)=11.31,P=0.001;Waldχ^(2)=22.54,P<0.001,respectively).The retinal thickness of fovea before and 1,3,6 and 12 months after surgery was(472.64±69.69)μm,(423.68±83.56)μm,(380.08±104.98)μm,(319.55±95.83)μm and 294.55±104.88μm,respectively,and the differences was statistically significant(Waldχ^(2)=1322.92,P<0.001).At 3,6 and 12 months postoperatively,there were significant differences in the thickness of macular fovea between the two groups(Waldχ^(2)=12.47,P<0.001;Waldχ^(2)=21.15,P<0.001;Waldχ^(2)=28.88,P<0.001,respectively).The thickness of ectopic internal fovea before and 1,3,6 and 12 months after surgery was(189.87±38.22)μm,(164.05±40.17)μm,(142.08±47.80)μm,(112.51±52.87)μm,and(91.49±53.25)μm,respectively,and the differences was statistically significant(Waldχ^(2)=969.82,P<0.001).At 3,6 and 12 months postoperatively,there were significant differences in the thickness of ectopic concave between the two groups(Waldχ^(2)=11.25,P=0.001;Waldχ^(2)=15.93,P<0.001;Waldχ^(2)=11.98,P=0.001,respectively).Conclusion Intravitreal injection of dexamethasone intravitreal implant in patients with idiopathic macular epiretinal membrane can assist the recovery of macular ultrastructure and visual function.