| Background and purposeCystoid macular edema(CME)is one of the common complications after pars plana vitrectomy(PPV).It is caused by serous exudation of retinal capillaries located between the extraretinal plexiform layer and the inner core layer.It can also be caused by swelling of Muller cells.It seriously affects the vision recovery of patients.At present,there are few reports on the incidence and treatment of CME after PPV.It may be related to the release of inflammatory factors during vitrectomy,previous eye diseases,systemic risk factors,surgical methods,intraoperative complications,systemic glucocorticoid use and drugs used during the perioperative period are related.The destruction of the blood-retinal barrier is the main pathogenesis.At present,the main treatment methods are local or systemic application of short-acting glucocorticoids,intravitreal injection of anti-VEGF drugs,non-steroidal anti-inflammatory drugs,carbonic anhydrase inhibitors,subcutaneous injection of interferon α-2a,drugs to promote the absorption of edema and improve microcirculation.Intraconjunctival or Tenon capsule injection of triamcinolone acetonide often needs multiple injections because of its short half-life,which is easy to increase the incidence of complications such as high intraocular pressure and cataract.After PPV,the eyes are filled with water samples,and there is no gel-like vitreous as a drug reservoir,which makes the intravitreal injection of triamcinolone acetonide or anti-VEGF drugs have a faster metabolism,short action time and limited efficacy.Due to the blood-retinal barrier,systemic application of glucocorticoid drugs may not achieve sufficient intraocular concentrations,and long-term high-dose application will increase systemic side effects,such as diabetes,hypertension,infection,and osteoporosis.In recent years,studies have reported that the dexamethasone intravitreal implant(Ozurdex)developed by the United States contains 0.7mg of dexamethasone,which can be completely biodegraded and can be continuously and smoothly released into the vitreous body within 6 months.The dexamethasone is completely biodegradable and has been used to treat cystoid macular edema after vitreoretinal surgery.In this study,patients with CME after PPV were treated with intravitreal injection of Ozurdex.The central macular thickness(CMT),the best corrected visual acuity(BCVA),intraocular pressure,and complications were measured at different time points before and after injection in the affected eye.Observe its efficacy and safety.Materials and MethodsRetrospective study design.Retrospective analysis of the ophthalmopathy of the First Affiliated Hospital of Zhengzhou University from November 2018 to September 2019.The clinical examination was confirmed as CME after PPV and received Ozurdex implantation clinical data of 24 patients(24 eyes)treated.including 12 males and 12 females.The age ranged from 13 to 70 years,with an average age of(55.46±12.17)years.The duration of disease ranged from 14 days to 12 months,with an average course of(47.00 ± 74.94)days.The subjects in this group were classified according to the primary disease of the affected eye,including 20 eyes(83.3%)with retinal detachment,2 eyes(8.3%)with retinal vein occlusion secondary to vitreous hemorrhage,2 eyes(8.3%)with macular anterior membrane.All eyes were injected with appropriate amount of triamcinolone acetonide in the vitreous after the operation.Regular eye examinations such as visual acuity,intraocular pressure,and anterior and posterior slit lamp examinations should be reviewed before and after treatment.At the same time,the patient was examined by optical correlation tomography,and the CMT was recorded.In the case of recurrence of CME or poor efficacy,the patients should be considered to be implanted in the glass again according to their own conditions.Statistical analysis was performed using statistical software SPSS 22.0.The quantitative data of the measurement indexes in this study are described by(x±s),and the count data are expressed by(%).The comparison of the BCVA before and after treatment and the CMT was performed by repeated measurement of single factor analysis of variance and further compared with each other by LSD-t test.The difference was statistically significant(P<0.05).ResultThe visual acuity(BCVA,logMAR)of the remaining 24 eyes before treatment was 0.90 ± 0.37,which was significantly improved to 0.73±0.33 at 1 month after treatment,and the BCVA continued to increase to 0.64±0.34 at 2 months after treatment,and after treatment from 2 months to 5 months,some patients with CME recurrence and chose to re-implant.After re-implantation,BCVA continued to increase,and 3 months,4 months,5 months,and 6 months after treatment were 0.62±0.35,0.55±0.32,0.54±0.28,0.53±0.28.the difference was statistically significant in visual acuity at each time point after treatment with before treatment(F=20.237,P=0.000),the difference in visual acuity between each time point after treatment was not statistically significant(P>0.05).The CMT before treatment in 24 eyes was(589.17±82.41)μm.The CMT at 1 month,2 months,3 months,4 months,5 months,and 6 months after treatment was(301.88 ±66.59)μm,(289.96 ±96.27)μm,and(341.63±98.69)μm,(337.29±112.15)μm,(337.92 ±135.37)μm,(322.42±115.01)μm,and the differences before and after treatment at each time point were statistically significant(F=40.819,P=0.000).There was no significant difference at all time points after treatment(P>0.05).During the follow-up period in 24 eyes,16 eyes(66.7%)only needed to be implanted once in Ozurdex,and 10 eyes(41.7%)had macular edema subsided after being implanted once in Ozurdex,and it was stable after 6 months follow-up;6 eyes(25%)of macular edema subsided after implantation of Ozurdex,and a small cystic cavity appeared again in the retina on average(3.33 ± 0.82)months.And the visual acuity did not decrease significantly,and oral absorption promoted edema absorption.After improving the microcirculation and other drugs,the edema gradually improved without the need for secondary implantation.8 eyes(33.3%)had a recurrence of CME at an average(3.13 ± 0.99)months.The degree of edema was still lower than that before surgery,but they needed to be implanted again,5 eyes chose to be implanted again,and 4 eyes gradually improved.A 13-year-old patient relapsed with cystoid macular edema after re-implantation 2 months as before;3 eyes continued to choose oral medication for personal reasons,of which 2 eyes had unchanged cystic macular edema.vision decreased and CME worsened in 1 eye.In 3 eyes(12.5%),the IOP increased≥25mmHg at 2 months after implantation.The IOP was controlled normally by one kind of intraocular pressure drop,and no recurrence was found after discontinuation.About 3 weeks after surgery,the Ozurdex stick entered the anterior chamber.In 3 eyes(12.5%),the stick entered the anterior chamber about 1 week after the operation,and the stick was returned to the vitreous body smoothly by different methods.After that,the pupil was constricted by using pupil shrinking agent and long-time head bending or bending was avoided.No such complications occurred again.One patient developed low intraocular pressure on the second day after surgery,the intraocular pressure returned to normal by covering both eyes and rest in bed.All patients had no serious ocular or systemic adverse reactions,such as retinal hiatus,retinal hemorrhage,and retinal detachment and so on.In conclusionThe intravitreal implantation of Ozurdex in the treatment of PME after PPV has a low incidence of complications and good safety.It can significantly improve vision and promote the absorption of retinal effusions.66.7%of the patients can be controlled with only one implantation,and 33.3%of the patients have relapsed CME about 3 months after surgery due to primary fundus disease,systemic disease,visual fatigue and other reasons,these patients need to be implanted in Ozurdex treatment before cure.Although the CME relapse,but its efficacy can still maintain for 2-3 months,thereby reducing the number of intraocular injections. |
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