微创玻璃体切除术中联合不同药物治疗特发性黄斑前膜的效果及患者房水内细胞因子的变化  

Observation on the efficacy and changes of cytolines in the aqueous humor of different drugs during minimally invasive vitrectomy on idiopathic macular epiretinal membrane

作　　者：高瑞莹 李仕永 王冰[1] 程婉 汤宇 孙静[1] Gao Ruiying;Li Shiyong;Wang Bing;Cheng Wan;Tang Yu;Sun Jing(Department of Ophthalmology,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210031,China)

机构地区：[1]南京医科大学第四附属医院眼科,南京210031

出　　处：《中华眼外伤职业眼病杂志》2024年第3期172-179,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察23 G微创玻璃体切除术中联合不同药物治疗特发性黄斑前膜的效果及手术前后患者房水内细胞因子浓度的变化。方法前瞻性随机对照研究。纳入2021年2月至2023年1月在南京医科大学第四附属医院眼科就诊的特发性黄斑前膜患者37例(37只眼),采用随机数字表法分为3组,对照组12例(12只眼)仅行23 G微创玻璃体视网膜术;曲安奈德(TA)组13例(13只眼)采用23 G微创玻璃体视网膜术中联合玻璃体腔注射曲安奈德;地塞米松玻璃体内植入剂(DEX)组12例(12只眼)采用23 G微创玻璃体视网膜术中联合玻璃体腔注射DEX。观察3组患者术前、术后的最佳矫正视力(BCVA,logMAR)、黄斑中心区视网膜厚度(CMT),同时收集3组患者术前、术后2周的房水,采用细胞因子微球检测技术(CBA)检测房水中白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-1β(IL-1β)、白细胞介素-2(IL-2)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、血管细胞黏附分子-1(VCAM-1)及肿瘤坏死因子-α(TNF-α)的浓度。结果3组患者术后2周、1个月、3个月、6个月BCVA、CMT比较:TA组BCVA与对照组比较差异均无统计学意义(均P>0.05),DEX组术后各时间点BCVA(0.63±0.10、0.56±0.08、0.48±0.06、0.45±0.06)均优于对照组BCVA(0.69±0.09、0.62±0.09、0.59±0.07、0.51±0.04)(均P<0.05);TA组CMT与对照组比较差异均无统计学意义(均P>0.05),DEX组术后各时间点CMT[(513.37±89.82)、(454.37±87.02)、(394.41±79.16)、(363.65±67.62)μm]均低于对照组[(537.87±91.33)、(514.37±81.03)、(462.56±81.16)、(419.65±57.76)μm](均P<0.05)。3组患者术后2周房水内IL-8、IL-6、IL-10、IL-1β、IL-2、VEGF、bFGF、VCAM-1及TNF-α浓度TA组与对照组比较差异均无统计学意义(均P>0.05),DEX组[(56.36±13.21)、(146.71±28.43)、(29.03±6.67)、(25.61±7.79)、(69.32±11.97)、(45.72±10.03)、(29.07±5.32)、(503.87±36.71)、(28.54±7.55Objective To observe the efficacy and the concentration of cytokines in the aqueous humor of different drugs during 23 G minimally invasive vitrectomy on idiopathic macular epiretinal membrane(iMEM)before and after surgery.Methods This was a prospective randomized controlled study.Thirty-seven eyes of 37 patients with iMEM in the Fourth Affiliated Hospital of Nanjing Medical University from Feb.2021 to Jan.2023 were included.Based on the random number table method,all patients were divided into 3 groups.In the control group,12 eyes of 12 cases were treated with 23 G minimally invasive vitrectomy.In the triamcinolone acetonide(TA)group,13 eyes of 13 cases were treated with 23 G minimally invasive vitreoretinal surgery combined with intravitreal injection of TA.In the dexamethasone intravitreal implant(DEX)group,12 eyes of 12 cases were treated with 23 G minimally invasive vitreoretinal surgery combined with intravitreal injection of DEX.The best corrected visual acuity(BCVA,logMAR)and central macular thickness(CMT)of the 3 groups were observed before and after surgery.This study collected aqueous humor from 3 groups before and 2 weeks after surgery and used cytometric bead array to detect the concentrations of interleukin-8(IL-8),interleukin-6(IL-6),interleukin-10(IL-10),interleukin-1β(IL-1β),interleukin-2(IL-2),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),vascular cell adhesion molecule-1(VCAM-1)and tumor necrosis factor-α(TNF-α).Results There were no statistically significant differences in the BCVA between the TA group and the control group(all P>0.05),while BCVA in the DEX group(0.63±0.10,0.56±0.08,0.48±0.06,0.45±0.06)were all better than those in the control group(0.69±0.09,0.62±0.09,0.59±0.07,0.51±0.04)at 2 weeks,1,3 and 6 months after surgery(all P<0.05).There were no statistically significant differences in the CMT between the TA group and the control group(all P>0.05)while the CMT in the DEX group[(513.37±89.82),(454.37±87.02),(394.41±79.16),(363.65±67.62)�

关 键 词：玻璃体切除术 曲安奈德 地塞米松 眼房水 细胞因子类 玻璃体腔注射 

分 类 号：R779.6[医药卫生—眼科]