MICROSTRUCTURAL CHANGES IN CYSTOID MACULAR EDEMA IN RETINITIS PIGMENTOSA AFTER INTRAVITREAL DEXAMETHASONE IMPLANT INJECTION
MICROSTRUCTURAL CHANGES IN CYSTOID MACULAR EDEMA IN RETINITIS PIGMENTOSA AFTER INTRAVITREAL DEXAMETHASONE IMPLANT INJECTION
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DOI：
10.1097/iae.0000000000002944
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发表时间：
2021-04-01
影响因子：
3.3
通讯作者：
Yu, Hyeong Gon
中科院分区：
文献类型：
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作者：
Park, Un Chul;Park, Jung Hyun;Yu, Hyeong Gon
目的：评价视网膜色素变性黄斑囊样水肿玻璃体腔内注射地塞米松后的显微结构变化。研究方法：在一项玻璃体内地塞米松植入治疗视网膜色素变性相关黄斑囊样水肿的随机试验的扩展队列中，使用光谱域光学相干断层扫描评估了治疗后6个月内的显微结构变化。结果：42只眼睛被纳入，并且在基线时在内核层（INL）中均存在囊样间隙。无视网膜下积液，28.6%有高反射灶。在INL和外核层/Henle's层均存在囊样间隙的38只眼中，13只（34.2%）在注射后2个月完全消退，12只（31.6%）仅在INL中存在囊样间隙，而其他人在两层均存在持续的囊样间隙。完全消退后，INL的囊样间隙复发早于外核层/Henle层。多变量分析显示，INL和外核层/Henle层的囊样间隙面积较大、黄斑渗漏的存在以及基线时完整的外界膜较长与治疗后囊样间隙面积减少较大相关。结论：地塞米松治疗后视网膜色素变性相关性黄斑囊样水肿的消退和复发模式表明，INL是囊性变化的主要层，这表明其发病机制最有可能是由Muller细胞功能障碍引起的。
Purpose: To evaluate microstructural changes in cystoid macular edema in retinitis pigmentosa after intravitreal dexamethasone implant injection. Methods: In an extended cohort of a randomized trial of intravitreal dexamethasone implant for the management of retinitis pigmentosa-associated cystoid macular edema, microstructural changes during six months after the treatment were evaluated using spectral-domain optical coherence tomography. Results: Forty-two eyes were included, and all had cystoid space in the inner nuclear layer (INL) at baseline. No eyes showed subretinal fluid, and 28.6% showed hyperreflective foci. Among 38 eyes with cystoid space both in the INL and outer nuclear layer/Henle's layer, 13 (34.2%) showed complete resolution and 12 (31.6%) showed cystoid space only in the INL at 2 months after injection, whereas others showed persistent cystoid space in both layers. After complete resolution, cystoid space recurrence was earlier in the INL than in the outer nuclear layer/Henle's layer. Multivariable analysis showed that greater cystoid space area in the INL and outer nuclear layer/Henle's layer, presence of macular leakage, and longer intact external limiting membrane at baseline were associated with greater cystoid space area decrease after the treatment. Conclusion: Resolution and recurrence pattern of retinitis pigmentosa-associated cystoid macular edema after dexamethasone treatment showed that the INL is the primary layer of cystic change, and this suggests its pathogenesis is most likely caused by Muller cell dysfunction.