Recalcitrant Macular Edema after Pseudophakic Rhegmatogenous Retinal Detachment Repair: Risk Factors and Response to Intravitreal Dexamethasone Implant.

IF 2.1 4区 医学 Q2 OPHTHALMOLOGY
Ophthalmologica Pub Date : 2025-02-26 DOI:10.1159/000543749
Francesco Pignatelli, Alfredo Niro, Pasquale Viggiano, Giacomo Boscia, Gianluca Besozzi, Cristiana Iaculli, Giuseppe Addabbo, Francesco Boscia, Ermete Giancipoli
{"title":"Recalcitrant Macular Edema after Pseudophakic Rhegmatogenous Retinal Detachment Repair: Risk Factors and Response to Intravitreal Dexamethasone Implant.","authors":"Francesco Pignatelli, Alfredo Niro, Pasquale Viggiano, Giacomo Boscia, Gianluca Besozzi, Cristiana Iaculli, Giuseppe Addabbo, Francesco Boscia, Ermete Giancipoli","doi":"10.1159/000543749","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to evaluate risk factors for recalcitrance to topical therapy of post-surgical macular edema (PSME) after rhegmatogenous retinal detachment (RRD) repair and its response to intravitreal dexamethasone implant (DEX-I).</p><p><strong>Methods: </strong>This two-center retrospective study reviewed the charts of pseudophakic patients who had undergone vitrectomy for RRD and experienced PSME within 6 months of surgery. A regression model analyzed the relationship between the recalcitrance of PSME to topical therapy and independent variables, including clinical data, surgical steps, and OCT parameters recorded at 1 month after surgery. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of eyes with responsive and recalcitrant PSME to topical therapy, the latest treated with DEX-I, were compared over follow-up.</p><p><strong>Results: </strong>Of the 361 eyes screened, 42 (11.7%) experienced PSME. Among those, all the eyes with recalcitrant PSME (21/42) received at least one DEX-I (1.38 ± 0.49 implant). The mean follow-up was 11.9 ± 0.3 months. Disrupted retinal outer layers (p = 0.02) and hyperreflective foci (HRF) (p = 0.01) were linked to recalcitrant PSME. An increased risk for recalcitrance was observed in the presence of HRF (OR: 7.69; IC: 1.31-44.9; p = 0.02). Over follow-up, BCVA and CMT were significantly (p < 0.01) worse in implanted eyes that experienced the more significant fluctuation of CMT (189.2 ± 104.7 µm (range: 58-409 µm); p < 0.01) with a reimplant rate of 42.8%. No one of the implanted eyes experienced ocular hypertension requiring intervention or other complications.</p><p><strong>Conclusion: </strong>HRF were found to be a risk factor for recalcitrance to topical therapy of PSME. Limited response to DEX-I was observed in such cases.</p>","PeriodicalId":19595,"journal":{"name":"Ophthalmologica","volume":" ","pages":"1-11"},"PeriodicalIF":2.1000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmologica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000543749","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: The aim of the study was to evaluate risk factors for recalcitrance to topical therapy of post-surgical macular edema (PSME) after rhegmatogenous retinal detachment (RRD) repair and its response to intravitreal dexamethasone implant (DEX-I).

Methods: This two-center retrospective study reviewed the charts of pseudophakic patients who had undergone vitrectomy for RRD and experienced PSME within 6 months of surgery. A regression model analyzed the relationship between the recalcitrance of PSME to topical therapy and independent variables, including clinical data, surgical steps, and OCT parameters recorded at 1 month after surgery. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of eyes with responsive and recalcitrant PSME to topical therapy, the latest treated with DEX-I, were compared over follow-up.

Results: Of the 361 eyes screened, 42 (11.7%) experienced PSME. Among those, all the eyes with recalcitrant PSME (21/42) received at least one DEX-I (1.38 ± 0.49 implant). The mean follow-up was 11.9 ± 0.3 months. Disrupted retinal outer layers (p = 0.02) and hyperreflective foci (HRF) (p = 0.01) were linked to recalcitrant PSME. An increased risk for recalcitrance was observed in the presence of HRF (OR: 7.69; IC: 1.31-44.9; p = 0.02). Over follow-up, BCVA and CMT were significantly (p < 0.01) worse in implanted eyes that experienced the more significant fluctuation of CMT (189.2 ± 104.7 µm (range: 58-409 µm); p < 0.01) with a reimplant rate of 42.8%. No one of the implanted eyes experienced ocular hypertension requiring intervention or other complications.

Conclusion: HRF were found to be a risk factor for recalcitrance to topical therapy of PSME. Limited response to DEX-I was observed in such cases.

假晶状体孔源性视网膜脱离修复后的顽固性黄斑水肿:危险因素和玻璃体内地塞米松植入的反应。
目的:评价孔源性视网膜脱离(RRD)修复术后黄斑水肿(PSME)局部治疗顽固性的危险因素及其对玻璃体内地塞米松植入物(DEX-I)的反应。方法:本研究为双中心回顾性研究,回顾了玻璃体切除术后6个月内发生pme的假性晶状体患者的病历。回归模型分析PSME对局部治疗的抗拒与自变量的关系,包括临床资料、手术步骤和术后1个月记录的OCT参数。通过随访比较了对局部治疗有反应性和顽固性PSME患者的最佳矫正视力(BCVA)和中央黄斑厚度(CMT)。结果:在筛查的361只眼睛中,42只(11.7%)出现了PSME。其中,顽固性PSME患者(21/42)均接受了至少1个DEX-I植入体(1.38±0.49)。平均随访11.9±0.3个月。视网膜外层破坏(p = 0.02)和高反射灶(HRF) (p = 0.01)与顽固性PSME有关。HRF存在时,顽固性风险增加(OR 7.69;Ic: 1.31- 44.9;P = 0.02)。随访中,CMT波动(189.2±104.7µm,范围:58 ~ 409µm)更显著的移植眼BCVA和CMT差(p < 0.01);P < 0.01),再植率为42.8%。所有植入的眼睛均未出现需要干预或其他并发症的高眼压。结论:HRF是局部治疗PSME难治性的危险因素。在这些病例中观察到dex - 1的有限反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Ophthalmologica
Ophthalmologica 医学-眼科学
CiteScore
5.10
自引率
3.80%
发文量
39
审稿时长
3 months
期刊介绍: Published since 1899, ''Ophthalmologica'' has become a frequently cited guide to international work in clinical and experimental ophthalmology. It contains a selection of patient-oriented contributions covering the etiology of eye diseases, diagnostic techniques, and advances in medical and surgical treatment. Straightforward, factual reporting provides both interesting and useful reading. In addition to original papers, ''Ophthalmologica'' features regularly timely reviews in an effort to keep the reader well informed and updated. The large international circulation of this journal reflects its importance.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信