Systemic corticosteroids reduce the risk of cellophane membranes after retinal detachment surgery: a prospective randomized placebo-controlled double-blind clinical trial
Systemic corticosteroids reduce the risk of cellophane membranes after retinal detachment surgery: a prospective randomized placebo-controlled double-blind clinical trial
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DOI：
10.1007/s00417-011-1919-y
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发表时间：
2012-07-01
影响因子：
2.7
通讯作者：
Garweg, Justus G.
中科院分区：
文献类型：
--
作者：
Koerner, Fritz;Koerner-Stiefbold, Ursula;Garweg, Justus G.
玻璃纸膜是视网膜脱离手术并发增生性玻璃体视网膜病变（PVR）的早期阶段。我们的目的是评估是否长期给予全身性皮质类固醇将减轻早期阶段的PVR，如玻璃纸膜。前瞻性随机安慰剂对照双盲临床试验。共有220例（220眼）连续的原发性孔源性视网膜脱离（RD），主要是通过巩膜扣带手术。将患者随机分为两组：110例患者（类固醇组）接受泼尼松治疗，从手术当天100 mg开始，逐渐减少至12.5 mg，共15天。对照组的110名患者以类似的方式接受安慰剂。术后1、3、6个月分别进行视力和视网膜检查，术后1、3、6个月玻璃膜发生率安慰剂组为41.8%、46.9%、39.1%，激素组为26.7%、23.6%、19.8（分别为p < 0.05、p = 0.0005和p < 0.005）。与类固醇组相比，使用5个或更多的冷冻凝固点与安慰剂组更多的玻璃纸膜形成病例相关（p < 0.05）。类固醇组95%的眼睛和安慰剂组89%的眼睛实现了视网膜完全复位，两组98%的眼睛实现了黄斑复位。两组的最终视力结果无显著差异。口服皮质类固醇可以减少视网膜脱离手术后的玻璃膜等早期PVR。
Cellophane membranes are an early stage of proliferative vitreoretinopathy (PVR) complicating retinal detachment surgery. Our aim was to assess whether a prolonged administration of systemic corticosteroids would attenuate early stages of PVR such as cellophane membranes.Prospective randomized placebo-controlled double-blind clinical trial.A total of 220 consecutive eyes (220 patients) were operated for primary rhegmatogenous retinal detachment (RD), mainly by scleral buckling procedures. Patients were randomized into two groups: 110 patients (steroid group) received prednisone for 15 days starting with 100 mg at the day of surgery and being tapered to 12.5 mg. The control group of 110 patients received placebo in a comparable manner. Follow-up examinations were performed at 1, 3 and 6 months postoperatively, and included visual acuity and assessment of retinal findings.Cellophane membranes occurred in 41.8%, 46.9%, and 39.1% in the placebo group and 26.7%, 23.6%, and 19.8% in the steroid group at 1, 3 and 6 months postoperatively (p < 0.05, = 0.0005, and < 0.005 respectively). The application of five or more cryocoagulation spots was associated with more cases developing cellophane membranes in the placebo than the steroid group (p < 0.05). A complete reattachment of the retina was achieved in 95% steroid and 89% placebo group eyes, and a reattachment of the macula in 98% of both groups. There was no significant difference of the final visual outcome in both groups.Early stages of PVR such as cellophane membranes after retinal detachment surgery can be reduced with corticosteroids in oral doses.