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±7.55)ng/L]均低于对照组[(136.41±28.72)、(329.47±59.31)、(51.51±10.32)、(61.76±12.55)、(151.84±29.88)、(83.72±17.88)、(51.13±9.08)、(893.41±89.26)、(59.56±13.76)ng/L](均P<0.05).随诊 6 个月,出现高眼压者对照组 3 例,TA组 4 例,DEX组 7 例,高眼压患者均给予 1～2 种降眼压滴眼液后眼压正常,3 组患者均未出现前房积血、眼内炎、视网膜脱离等严重并发症.结论 特发性黄斑前膜患者行 23 G微创玻璃体切除术联合DEX治疗可减轻患者的黄斑水肿,提高视力,且明显抑制患者房水血管生成因子和炎症因子.
Abstract
Objective 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)μm]were all lower than those in the control group[(537.87±91.33),(514.37±81.03),(462.56±81.16),(419.65±57.76)μm]at 2 weeks,1,3 and 6 months after surgery(all P<0.05).There were no statistically significant differences in the concentrations of IL-8,IL-6,IL-10,IL-1β,IL-2,VEGF,bFGF,VCAM-1 and TNF-α in aqueous humor between the TA group and the control group(all P>0.05)while the concentrations of IL-8,IL-6,IL-10,IL-1β,IL-2,VEGF,bFGF,VCAM-1 and TNF-α in aqueous humor in the DEX group[(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±7.55)ng/L]were all lower than those in the control group[(136.41±28.72),(329.47±59.31),(51.51±10.32),(61.76±12.55),(151.84±29.88),(83.72±17.88),(51.13±9.08),(893.41±89.26),(59.56±13.76)ng/L]at 2 weeks after surgery(all P<0.05).Follow-up for 6 months,there were 3 cases of high intraocular pressure in the control group,4 cases in the in the TA group and 7 cases in the DEX group.All patients with high intraocular pressure had normal intraocular pressure after receiving 1 or 2 types of hypotensive eye drops.No serious complications such as anterior chamber hemorrhage,endophthalmitis or retinal detachment were observed in 3 groups.Conclusion 23 G minimally invasive vitrectomy combined with DEX treatment can reduce macular edema,improve the visual acuity of patients with iMEM,and inhibit the angiogenic factors and inflammatory factors of aqueous humor.
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