Short-term clinical study of vitrectomy combined with intraoperative slow-release dexamethasone implantation in the treatment of severe idiopathic macular epiretinal membrane_Chinese Journal of Ocular Fundus Diseases

Authors：

Wei Jiaoting , Liu Boshi , Yang Meng , Pang Shaofang , Nie Zetong , Zhang Xiang , Shi Yi , Li Wenbo ,  Hu Bojie

Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China;

Corresponding author：

Hu Bojie, Email: bhu07@tmu.edu.cn

Keywords：

Vitrectomy; Dexamethasone; Intravitreal injections; Idiopathic macular anterior membrane

DOI：

10.3760/cma.j.cn511434-20220216-00091

Video：

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Objective To observe the efficacy of dexamethasone intravitreal implant (DEX) combined with pars plana vitrectomy (PPV) in eyes with severe idiopathic epimacular membrane (IMEM). Methods A prospective clinical case study. From December 2018 to May 2021, 24 patients with 25 eyes of severe IMEM diagnosed in Tianjin Medical University Eye Hospital were included in the study. Among them, 7 males had 7 eyes, 17 females had 18 eyes. Age was 57 to 84 years old. The IMEM stage was 3 to 4 examined by spectral domain optical coherence tomography (SD-OCT). All eyes were performed best corrected visual acuity (BCVA) and central macular thickness (CMT) by SD-OCT. The patients were randomly divided into PPV group (11 eyes) and PPV+DEX group (14 eyes). Standard PPV by three-channel 25G was performed. Phacoemulsification, membrane stripping and intraocular lens implantation were combined during the operation. Patients received vitreous injection of 0.7 mg DEX in PPV+DEX group at the end of the operation. At 1 week, 1 month, 3 months and 6 months after operation, the same equipments and methods were used to perform relevant examinations. The changes of BCVA and CMT were compared between the two groups by t test. Results Compared with before operation, at 1, 3 and 6 months after operation, the BCVA of the eyes in the PPV+DEX group was significantly improved (t=3.974, 4.639, 4.453), CMT was significantly decreased (t=2.955, 3.722, 4.364), the differences were statistically significant (P＜0.05); at 3 and 6 months after surgery, the BCVA of the eyes in the PPV group was significantly improved (t=2.983, 4.436), CMT was significantly decreased (t=2.983, 3.461), the differences were statistically significant (P＜0.05). Conclusion In the treatment of severe IMEM, DEX can accelerate the early postoperative visual recovery and reduce CMT.

Citation： Wei Jiaoting, Liu Boshi, Yang Meng, Pang Shaofang, Nie Zetong, Zhang Xiang, Shi Yi, Li Wenbo, Hu Bojie. Short-term clinical study of vitrectomy combined with intraoperative slow-release dexamethasone implantation in the treatment of severe idiopathic macular epiretinal membrane. Chinese Journal of Ocular Fundus Diseases, 2022, 38(10): 793-798. doi: 10.3760/cma.j.cn511434-20220216-00091 Copy

1.	Kim JH, Kang SW, Kong MG, et al. Assessment of retinal layers and visual rehabilitation after epiretinal membrane removal[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(4): 1055-1064. DOI: 10.1007/s00417-012-2120-7.
2.	Kim J, Rhee KM, Woo SJ, et al. Long-term temporal changes of macular thickness and visual outcome after vitrectomy for idiopathic epiretinal membrane[J]. Am J Ophthalmol, 2010, 150(5): 701-709. DOI: 10.1016/j.ajo.2010.05.037.
3.	Chang YC, Lin CC, Wu WC. Long-term anatomical and functional outcome of three intravitreal bevacizumab injections for persistent macular edema after idiopathic macular epiretinal membrane peeling[J]. Ophthalmologica Extra, 2014, 1(1): 1-8. DOI: 10.1159/000360185.
4.	Chatziralli I, Dimitriou E, Theodossiadis G, et al. Treatment of macular edema after pars plana vitrectomy for idiopathic epiretinal membrane using intravitreal dexamethasone implant: long-term outcomes[J]. Ophthalmologica, 2019, 242(1): 16-21. DOI: 10.1159/000496705.
5.	Kim SJ, Martin DF, Hubbard GR, et al. Incidence of postvitrectomy macular edema using optical coherencetomography[J]. Ophthalmology, 2009, 116(8): 1531-1537. DOI: 10.1016/j.ophtha.2009.02.008.
6.	Shaikh AH, Petersen MR, Sisk RA, et al. Comparative effectiveness of the dexamethasone intravitreal implant in vitrectomized and non-vitrectomized eyes with macular edema secondary to central retinal vein occlusion[J]. Ophthalmic Surg Lasers Imaging Retina, 2013, 44(1): 28-33. DOI: 10.3928/23258160-20121221-09.
7.	Haller JA, Bandello F, Belfort RJ, et al. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion[J]. Ophthalmology, 2010, 117(6): 1134-1146. DOI: 10.1016/j.ophtha.2010.03.032.
8.	Boyer DS, Faber D, Gupta S, et al. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients[J]. Retina, 2011, 31(5): 915-923. DOI: 10.1097/IAE.0b013e318206d18c.
9.	Pohlmann D, Vom BG, Winterhalter S, et al. Dexamethasone inserts in noninfectious uveitis: a single-center experience[J]. Ophthalmology, 2018, 125(7): 1088-1099. DOI: 10.1016/j.ophtha.2017.12.038.
10.	Khurana RN, Porco TC. Efficacy and safety of dexamethasone intravitreal implant for persistent uveitic cystoid macular edema[J]. Retina, 2015, 35(8): 1640-1646. DOI: 10.1097/IAE.0000000000000515.
11.	Bucolo C, Gozzo L, Longo L, et al. Long-term efficacy and safety profile of multiple injections of intravitreal dexamethasone implant to manage diabetic macular edema: a systematic review of real-world studies[J]. J Pharmacol Sci, 2018, 138(4): 219-232. DOI: 10.1016/j.jphs.2018.11.001.
12.	Chang-Lin JE, Burke JA, Peng Q, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4605-4609. DOI: 10.1167/iovs.10-6387.
13.	Frisina R, Pinackatt SJ, Sartore M, et al. Cystoid macular edema after pars plana vitrectomy for idiopathic epiretinal membrane[J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(1): 47-56. DOI: 10.1007/s00417-014-2655-x.
14.	Iovino C, Giannaccare G, Pellegrini M, et al. Efficacy and safety of combined vitrectomy with intravitreal dexamethasone implant for advanced stage epiretinal membrane[J]. Drug Des Devel Ther, 2019, 13: 4107-4114. DOI: 10.2147/DDDT.S229031.
15.	Savastano A, Bitossi A, Giansanti F, et al. Evaluation of intraoperative slow-release dexamethasone implant combined with idiopathic epiretinal membrane removal[J]. Graefe's Arch Clin Exp Ophthalmol, 2021, 259(2): 379-385. DOI: 10.1007/s00417-020-04911-5.
16.	Guidi G, Casini G, Ripandelli G, et al. Residual intrareinal edema after 25-gauge vitrectomy and macular pucker removal: intraoperative sustained-release dexamethasone a real treatment option?[J]. Retina, 2018, 38(5): 993-999. DOI: 10.1097/IAE.0000000000001627.
17.	Govetto A, Lalane RR, Sarraf D, et al. Insights into epiretinal membranes: presence of ectopic inner foveal layers and a new optical coherence tomography staging scheme[J]. Am J Ophthalmol, 2017, 175: 99-113. DOI: 10.1016/j.ajo.2016.12.006.
18.	Schulze-Bonsel K, Feltgen N, Burau H, et al. Visual acuities "hand motion" and "counting fingers" can be quantified with the freiburg visual acuity test[J]. Invest Ophthalmol Vis Sci, 2006, 47(3): 1236-1240. DOI: 10.1167/iovs.05-0981.
19.	Suzuki T, Hayakawa K, Nakagawa Y, et al. Topical dorzolamide for macular edema in the early phase after vitrectomy and epiretinal membrane removal[J]. Clin Ophthalmol, 2013, 7: 549-553. DOI: 10.2147/OPTH.S42188.
20.	Hattenbach LO, Springer-Wanner C, et al. Intravitreal sustained-release steroid implants for the treatment of macular edema following surgical removal of epiretinal membranes[J]. Ophthalmologica, 2017, 237(4): 232-237. DOI: 10.1159/000464259.
21.	张红梅, 刘洪涛. 特发性黄斑前膜形成的危险因素及发生机制的研究现状[J]. 中华眼底病杂志, 2021, 37(8): 651-655. DOI: 10.3760/cma.j.cn511434-20200612-00279.Zhang HM, Liu HT. The study of the risk factors and pathogenesis of idiopathic epimacular membrane[J]. Chin J Ocul Fundus Dis, 2021, 37(8): 651-655. DOI: 10.3760/cma.j.cn511434-20200612-00279.
22.	Bellocq D, Korobelnik JF, Burillon C, et al. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study[J]. Br J Ophthalmol, 2015, 99(7): 979-983. DOI: 10.1136/bjophthalmol-2014-306159.
23.	Bellocq D, Pierre-Kahn V, Matonti F, et al. Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine-Gass syndrome: the EPISODIC-2 study[J]. Br J Ophthalmol, 2017, 101(3): 333-341. DOI: 10.1136/bjophthalmol-2016-308544.
24.	Parisi G, Fallico M, Avitabile T, et al. Intravitreal dexamethasone implant for postoperative macular oedema secondary to vitrectomy for epiretinal membrane and retinal detachment: a systematic review and meta-analysis[J/OL]. J Ophthalmol, 2021, 2021: 6627677[2021-04-16]. https://pubmed.ncbi.nlm.nih.gov/33953965/. DOI: 10.1155/2021/6627677.
25.	Chang-Lin JE, Attar M, Acheampong AA, et al. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant[J]. Invest Ophthalmol Vis Sci, 2011, 52(1): 80-86. DOI: 10.1167/iovs.10-5285.
26.	Chang YC, Liu PK, Kao TE, et al. Dexamethasone intravitreal implant (Ozurdex) for long-term macular edema after epiretinal membrane peeling surgery[J/OL]. J Ophthalmol, 2018, 2018: 5832186[2018-12-10]. https://pubmed.ncbi.nlm.nih.gov/30693103/. DOI: 10.1155/2018/5832186.
27.	Furino C, Boscia F, Recchimurzo N, et al. Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker[J]. Retina, 2014, 34(8): 1612-1616. DOI: 10.1097/IAE.0000000000000105.
28.	Sane SS, Ali MH, Kuppermann BD, et al. Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane[J]. Indian J Ophthalmol, 2020, 68(6): 1103-1107. DOI: 10.4103/ijo.IJO_1045_19.

1. Kim JH, Kang SW, Kong MG, et al. Assessment of retinal layers and visual rehabilitation after epiretinal membrane removal[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(4): 1055-1064. DOI: 10.1007/s00417-012-2120-7.
2. Kim J, Rhee KM, Woo SJ, et al. Long-term temporal changes of macular thickness and visual outcome after vitrectomy for idiopathic epiretinal membrane[J]. Am J Ophthalmol, 2010, 150(5): 701-709. DOI: 10.1016/j.ajo.2010.05.037.
3. Chang YC, Lin CC, Wu WC. Long-term anatomical and functional outcome of three intravitreal bevacizumab injections for persistent macular edema after idiopathic macular epiretinal membrane peeling[J]. Ophthalmologica Extra, 2014, 1(1): 1-8. DOI: 10.1159/000360185.
4. Chatziralli I, Dimitriou E, Theodossiadis G, et al. Treatment of macular edema after pars plana vitrectomy for idiopathic epiretinal membrane using intravitreal dexamethasone implant: long-term outcomes[J]. Ophthalmologica, 2019, 242(1): 16-21. DOI: 10.1159/000496705.
5. Kim SJ, Martin DF, Hubbard GR, et al. Incidence of postvitrectomy macular edema using optical coherencetomography[J]. Ophthalmology, 2009, 116(8): 1531-1537. DOI: 10.1016/j.ophtha.2009.02.008.
6. Shaikh AH, Petersen MR, Sisk RA, et al. Comparative effectiveness of the dexamethasone intravitreal implant in vitrectomized and non-vitrectomized eyes with macular edema secondary to central retinal vein occlusion[J]. Ophthalmic Surg Lasers Imaging Retina, 2013, 44(1): 28-33. DOI: 10.3928/23258160-20121221-09.
7. Haller JA, Bandello F, Belfort RJ, et al. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion[J]. Ophthalmology, 2010, 117(6): 1134-1146. DOI: 10.1016/j.ophtha.2010.03.032.
8. Boyer DS, Faber D, Gupta S, et al. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients[J]. Retina, 2011, 31(5): 915-923. DOI: 10.1097/IAE.0b013e318206d18c.
9. Pohlmann D, Vom BG, Winterhalter S, et al. Dexamethasone inserts in noninfectious uveitis: a single-center experience[J]. Ophthalmology, 2018, 125(7): 1088-1099. DOI: 10.1016/j.ophtha.2017.12.038.
10. Khurana RN, Porco TC. Efficacy and safety of dexamethasone intravitreal implant for persistent uveitic cystoid macular edema[J]. Retina, 2015, 35(8): 1640-1646. DOI: 10.1097/IAE.0000000000000515.
11. Bucolo C, Gozzo L, Longo L, et al. Long-term efficacy and safety profile of multiple injections of intravitreal dexamethasone implant to manage diabetic macular edema: a systematic review of real-world studies[J]. J Pharmacol Sci, 2018, 138(4): 219-232. DOI: 10.1016/j.jphs.2018.11.001.
12. Chang-Lin JE, Burke JA, Peng Q, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4605-4609. DOI: 10.1167/iovs.10-6387.
13. Frisina R, Pinackatt SJ, Sartore M, et al. Cystoid macular edema after pars plana vitrectomy for idiopathic epiretinal membrane[J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(1): 47-56. DOI: 10.1007/s00417-014-2655-x.
14. Iovino C, Giannaccare G, Pellegrini M, et al. Efficacy and safety of combined vitrectomy with intravitreal dexamethasone implant for advanced stage epiretinal membrane[J]. Drug Des Devel Ther, 2019, 13: 4107-4114. DOI: 10.2147/DDDT.S229031.
15. Savastano A, Bitossi A, Giansanti F, et al. Evaluation of intraoperative slow-release dexamethasone implant combined with idiopathic epiretinal membrane removal[J]. Graefe's Arch Clin Exp Ophthalmol, 2021, 259(2): 379-385. DOI: 10.1007/s00417-020-04911-5.
16. Guidi G, Casini G, Ripandelli G, et al. Residual intrareinal edema after 25-gauge vitrectomy and macular pucker removal: intraoperative sustained-release dexamethasone a real treatment option?[J]. Retina, 2018, 38(5): 993-999. DOI: 10.1097/IAE.0000000000001627.
17. Govetto A, Lalane RR, Sarraf D, et al. Insights into epiretinal membranes: presence of ectopic inner foveal layers and a new optical coherence tomography staging scheme[J]. Am J Ophthalmol, 2017, 175: 99-113. DOI: 10.1016/j.ajo.2016.12.006.
18. Schulze-Bonsel K, Feltgen N, Burau H, et al. Visual acuities "hand motion" and "counting fingers" can be quantified with the freiburg visual acuity test[J]. Invest Ophthalmol Vis Sci, 2006, 47(3): 1236-1240. DOI: 10.1167/iovs.05-0981.
19. Suzuki T, Hayakawa K, Nakagawa Y, et al. Topical dorzolamide for macular edema in the early phase after vitrectomy and epiretinal membrane removal[J]. Clin Ophthalmol, 2013, 7: 549-553. DOI: 10.2147/OPTH.S42188.
20. Hattenbach LO, Springer-Wanner C, et al. Intravitreal sustained-release steroid implants for the treatment of macular edema following surgical removal of epiretinal membranes[J]. Ophthalmologica, 2017, 237(4): 232-237. DOI: 10.1159/000464259.
21. 张红梅, 刘洪涛. 特发性黄斑前膜形成的危险因素及发生机制的研究现状[J]. 中华眼底病杂志, 2021, 37(8): 651-655. DOI: 10.3760/cma.j.cn511434-20200612-00279.Zhang HM, Liu HT. The study of the risk factors and pathogenesis of idiopathic epimacular membrane[J]. Chin J Ocul Fundus Dis, 2021, 37(8): 651-655. DOI: 10.3760/cma.j.cn511434-20200612-00279.
22. Bellocq D, Korobelnik JF, Burillon C, et al. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study[J]. Br J Ophthalmol, 2015, 99(7): 979-983. DOI: 10.1136/bjophthalmol-2014-306159.
23. Bellocq D, Pierre-Kahn V, Matonti F, et al. Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine-Gass syndrome: the EPISODIC-2 study[J]. Br J Ophthalmol, 2017, 101(3): 333-341. DOI: 10.1136/bjophthalmol-2016-308544.
24. Parisi G, Fallico M, Avitabile T, et al. Intravitreal dexamethasone implant for postoperative macular oedema secondary to vitrectomy for epiretinal membrane and retinal detachment: a systematic review and meta-analysis[J/OL]. J Ophthalmol, 2021, 2021: 6627677[2021-04-16]. https://pubmed.ncbi.nlm.nih.gov/33953965/. DOI: 10.1155/2021/6627677.
25. Chang-Lin JE, Attar M, Acheampong AA, et al. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant[J]. Invest Ophthalmol Vis Sci, 2011, 52(1): 80-86. DOI: 10.1167/iovs.10-5285.
26. Chang YC, Liu PK, Kao TE, et al. Dexamethasone intravitreal implant (Ozurdex) for long-term macular edema after epiretinal membrane peeling surgery[J/OL]. J Ophthalmol, 2018, 2018: 5832186[2018-12-10]. https://pubmed.ncbi.nlm.nih.gov/30693103/. DOI: 10.1155/2018/5832186.
27. Furino C, Boscia F, Recchimurzo N, et al. Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker[J]. Retina, 2014, 34(8): 1612-1616. DOI: 10.1097/IAE.0000000000000105.
28. Sane SS, Ali MH, Kuppermann BD, et al. Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane[J]. Indian J Ophthalmol, 2020, 68(6): 1103-1107. DOI: 10.4103/ijo.IJO_1045_19.

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Short-term clinical study of vitrectomy combined with intraoperative slow-release dexamethasone implantation in the treatment of severe idiopathic macular epiretinal membrane

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