당뇨황반부종의 치료에서 유리체 절제술의 효과와 유리체강내 트리암시놀론 주입술과의 비교

Abstract

Purpose: The purpose of this study is to evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in diabetic macular edema, and to compare the effects of PPV and removal of ILM with intravitreal triamcinolone acetonide injection. Methods: Fifteen eyes of 14 patients on whom PPV and removal of the ILM (group A) were performed and 14 eyes of 14 patients who received single intravitreal triamcinolone acetonide injection (group B) for diabetic macular edema over six months were included in this study. The main outcome measures were macular thickness, as measured by optical coherence tomography and visual acuity at 1, 3, and 6 months postoperatively. Results: The mean preoperative visual acuity was 0.06±0.05 and macular thickness 516.01±120.29㎛ in group A. At 1 month postoperatively, this group showed no significant improvement of visual acuity. However, there was significant improvement at 3 and 6 months postoperatively. Macular thickness also decreased significantly at 1, 3, and 6 months postoperatively. In group B, the mean preoperative visual acuity was 0.10±0.08 and macular thickness was 548.82±116.44㎛. At 1 and 3 months postoperatively, significant improvement of visual acuity was noted in this group. However, there was no significant difference at 6 months postoperatively. Macular thickness also decreased significantly at 1, 3, and 6 month postoperatively. Between two groups, visual acuity and macular thickness improved in Group B at 1 month postoperatively but at 6 months, visual acuity improved in Group A and there was no significant difference of macular thickness between the two groups. Conclusions: PPV and removal of the ILM are good therapeutic options for diabetic macular edema to improve visual acuity and macular thickness. These also offer more long term efficacy than intravitreal tiamcinolone acetonide injection.