玻璃体切割术联合地塞米松玻璃体内植入剂治疗黄斑前膜的临床疗效分析  

Clinical analysis of vitrectomy combined with dexamethasone intraveal implant in the treatment of epiretinal membrane

作　　者：吴琨芳 郭美美 李翔[1] 王丁丁[1] WU Kunfang;GUO Meimei;LI Xiang;WANG Dingding(Huizhou Central People’s Hospital,Huizhou 516001,China)

机构地区：[1]惠州市中心人民医院,惠州516001

出　　处：《眼科学报》2025年第2期113-126,共14页Eye Science

基　　金：广东省惠州市科技计划项目(2023CZ010032)。

摘　　要：目的:对比玻璃体切割术(pars plana vitrectomy, PPV)联合或不联合注射地塞米松玻璃体内植入剂(dexamethasone intraveal implant, DEX)治疗特发性黄斑前膜(idiopathic macular epiretinal membrane, IMEM)的临床疗效。方法:采用回顾性研究设计,收集2022年1月—2023年6月于惠州市中心人民医院就诊,被诊断为IMEM(Gass 2期)并行PPV联合phaco+IOL植入的患者49例(49只眼)。根据其治疗方案分为非联合注射DEX组(25例共25只眼)及联合注射DEX组(24例共24只眼)。记录所有患者术前术后的最佳矫正视力(best corrected visual acuity, BCVA)、黄斑中心凹视网膜厚度(central macular thickness, CMT)、平均神经节细胞层(ganglion cell layer, GCL)厚度,椭圆体带(ellipsoidal zone, EZ)完整性。使用OCTA测量视网膜浅层毛细血管层(superficial capillary plexus, SCP)、中心区域血管密度(vessel densities, VDs)及中心凹无血管区(foveal avascularzone,FAZ)面积。使用非接触性眼压计测量患者眼压。随访至术后6个月,记录上述指标,其中BCVA及CMT随访至1年。使用SPSS 29.0软件进行数据的统计分析(独立样本t检验、Mann-Whitney U检验、Pearsonχ^(2)检验等)。使用重复测量方差检验分析各项指标的时间差异及交互差异性。采用线性回归分析CMT、平均GCL厚度、EZ完整性、VDs、FAZ面积及联合注射DEX与BCVA的相关性。结果:本研究两组间性别、年龄、眼压及术前各项指标差异均无统计学意义(P>0.05)。两种术式均能改善黄斑区结构、功能及微循环障碍,术后的BCVA在两组患者中均较术前有所改善,且持续至术后6个月,CMT的变化趋势同BCVA有高度一致性,而平均GCL厚度于术后3个月时开始恢复,而SCP中心凹VDs及FAZ面积于术后6个月时才有明显恢复,两种术式术后以上各指标均具有时间差异及交互差异性(P≤0.015),且6个月内联合注射DEX组表现更佳(P=0.036)。相较于非联合注射DEX组,只有联合注射DEX组在�Objective:To analyze the efficacy and safety of minimally invasive vitrectomy(PPV)with or without intraoperative injection of dexamethasone intravitreal implant(DEX)for the treatment of Idiopathic Macular Epiretinal Membrane(IMEM),by comparing the relevant indicators.Methods:A retrospective study design was used to collect 49 patients(49 eyes)who were diagnosed with IMEM(Gass2)and underwent surgical treatment(PPV+phaco+IOL implantation)at Huizhou Central People’s Hospital from January 2022 to June 2023.According to their treatment plan,they were divided into a non-combined injection DEX group(25 cases,25 eyes)and a combined injection DEX group(24 cases,24 eyes).All patients underwent comprehensive optometry before and after surgery,and their best corrected visual acuity(BCVA)was recorded.Scan the central macular thickness(CMT)within 6x6mm of the macular area,while scanning the average ganglion cell layer(GCL)thickness.Record whether the elliptical zone(EZ)within 1x1mm of the macular area is complete and continuous.Use OCTA mode to scan the superficial capillary layer(SCP)of the retina within a range of 6x6mm,and record the measurements of vascular density(VDs)in the central area and the area of the foveal avascular zone(FAZ).Measure the patient's intraocular pressure using a non-contact tonometer.Follow up for 6 months and record the above indicators,with BCVA and CMT followed up for 1 year.Perform statistical analysis of data using SPSS 29.0 software(Independent sample t-test,Mann Whitney U-test and Pearsonχ²-test).Use repeated measures ANOVA to analyze the time differences and interaction differences of various indicators.Linear regression analysis was used to examine the correlation between CMT,mean GCL thickness,EZ integrity,VDs,FAZ area,and combined injection of DEX with BCVA.Results:There were no statistically significant differences in gender,age,intraocular pressure,and preoperative indicators between the two groups(P>0.05).Both surgical methods can improve the structure,function,and microcirculation

关 键 词：地塞米松 玻璃体内植入剂 特发性黄斑前膜 黄斑区微结构 

分 类 号：R774.5[医药卫生—眼科] R779.62[医药卫生—临床医学]