| Purpose: Secondary macular edema(ME)and optic neuropathy are important factors affecting the prognosis of postoperative visual function in patients with retinal detachment with silicone oil filling.For secondary ME,clinical treatment with vitreous cavity injection of glucocorticoids or vascular endothelial growth factor(VEGF)drugs is performed.VEGF and glucocorticoids have neuroprotective effects.The purpose of this study was to analyze the neuroprotective effects of VEGF and glucocorticoids on the macular retina,the ganglion cell complex(GCC),and the retinal nerve fiber layer(RN)of the optic disc after injection of both drugs using spectral domain optical coherence tomography(SD-OCT).The changes in the thickness of the retinal nerve fiber(RNFL)were analyzed to assess the effects of different drugs on secondary ME and on the optic nerve.Method: In this retrospective study,26 cases and 26 eyes of 26 patients who attended Dalian Medical UniversityEye Center from December 2020 to December 2022 and were diagnosed with ME secondary to retinal detachment after silicone oil filling by fundoscopy combined with SD-OCT were selected and divided into anti-VEGF injection group and glucocorticoid injection group by random grouping.In a study analyzing the changes in macular retinal thickness and macular GCC thickness before and 1 month after anti-VEGF injection and glucocorticoid injection,13 eyes of 13 patients in the anti-VEGF injection group and 13 eyes of 13 patients in the glucocorticoid injection group were selected from 26cases and 26 eyes,and an area 7 mm×7 mm from the central macular recess was measured by SD-OCT,and two radiographic lines were used to divide the scanned area into The scanned area was divided into the central macular region,the superior region,the inferior region,the nasal region and the temporal region,and the thickness measurements of each partition were performed to analyze the effects of different drug injections on the ME and GCC thickness in the macular region.In the study to analyze the changes of RNFL thickness in the optic disc area before and 1 month after anti-VEGF injection and glucocorticoid injection,9 eyes of 9 cases in the anti-VEGF injection group and 8 eyes of 8 cases in the glucocorticoid injection group were selected from 26 cases and 26 eyes,and the thickness measurements of RNFL in the superior region,inferior region,nasal region and temporal region of the optic disc area were performed using SD-OCT,and the effects of different drug injections on the thickness of RNFL in the optic disc area were analyzed.The effects of different drugs on the thickness of the RNFL in the optic disc were analyzed.All data were summarized and analyzed by IBM SPSS Statistics Version 26.0,and Fisher’s exact test was used to compare the count data of the two groups.All the measurement data were tested for normal distribution,and the t-test for independent samples was used for the comparison of two groups of measurement data conforming to normal distribution,and the Mann-Whitney test was used for the comparison of two groups of measurement data not conforming to normal distribution,and the difference was considered statistically significant when P<0.05.Results:1.Preoperative and 1-month postoperative macular area retinal thickness measurements in the anti-VEGF injection group and the glucocorticoid injection group:1.1 Preoperative in both groups:No statistical difference in retinal thickness in the superior region,inferior region,nasal region and temporal region before surgery;1.2 Postoperative in both groups:No statistical difference in retinal thickness in the superior region,inferior region,nasal region,and temporal region postoperatively;1.3 Pre-and post-operative in the anti-VEGF injection group:Retinal thickness in the central region: before injection: 316.31±71.98(μm),after injection: 220.46±95.21(μm),with statistical differences between the two comparisons(P=0.008<0.05);Retinal thickness in the superior region: before drug injection: 335.62±95.01(μm),after drug injection: 303.23±107.56(μm),with statistical differences between the two comparisons(P=0.035<0.05)Retinal thickness in the inferior region: before drug injection: 334.62±69.13(μm),after drug injection: 331.92±66.97(μm),with statistical differences between the two comparisons(P=0.031<0.05)Retinal thickness in the nasal region: before drug injection: 475.54±254.69(μm),after drug injection: 442.00±222.25(μm),with a statistical difference between the two comparisons(P=0.023<0.05);There was no statistical difference in retinal thickness in the temporal region before and after drug injection;1.4 Pre-and postoperative glucocorticoid injection groups:Retinal thickness in the central region: before drug injection: 307.23±74.94(μm),after drug injection: 222.46±55.79(μm),with statistical differences between the two comparisons(P=0.001,P<0.05);There was no statistical difference in retinal thickness in the superior region,inferior region,nasal region and temporal region before and after drug injection;2.2.Preoperative and 1-month postoperative macular area GCC thickness measurements in the anti-VEGF injection group and the glucocorticoid injection group:2.1 Preoperative in both groups:No statistical difference in GCC thickness in the superior region,inferior region,nasolateral region and temporal region before surgery;2.2 Postoperative in both groups:Retinal thickness in the nasal region: anti-VEGF group: 91.77±42.76(μm),hormone group: 129.23±46.40(μm),with statistical differences between the two comparisons(P=0.013<0.05);No statistical difference in postoperative GCC thickness in the superior region,inferior region,and temporal region;2.3 Preoperative and postoperative in the anti-VEGF injection group:Retinal thickness in the nasal region: before injection: 121.08±56.20(μm),after injection: 91.77±42.76(μm),with statistical differences between the two comparisons(P=0.006<0.05);There was no statistical difference in the thickness of GCC in the superior region,inferior region and temporal region before and after drug injection;2.4 Pre-and postoperative glucocorticoid injection groups:No statistical difference in GCC thickness in the superior region,inferior region,nasal region,and temporal region before and after drug injection;3.3.Preoperative and 1-month postoperative RNFL thickness measurements of the optic disc area in the anti-VEGF injection group and the glucocorticoid injection group:3.1 Preoperative in both groups:No statistical difference in RNFL thickness in the superior region,inferior region,nasal region,and temporal region of the optic disc area before surgery;3.2 Postoperative in both groups:No statistical difference in RNFL thickness in the superior region,the inferior region,the nasal region,and the temporal region in the optic disc area postoperatively;3.3 Pre-and post-operative in the anti-VEGF injection group:Retinal thickness in the nasal region: before injection: 116.44±34.19(μm),after injection: 86.11±26.89(μm),with statistical differences between the two comparisons(P=0.021<0.05);There was no statistical difference in the thickness of p RNFL in the superior region,the inferior region,and the temporal region before and after drug injection;3.4 Pre-and postoperative glucocorticoid injection groups:No statistical difference in RNFL thickness in the superior region,inferior region,nasal region,and temporal region in the optic disc region before and after drug injection;Conclusions:1.Both vitreous cavity injections of glucocorticoids and anti-VEGF drugs were effective in relieving ME secondary to retinal detachment silicone oil filling.2.1 month after surgery,the GCC thickness in the nasal region of the retinal macula was thinner than before surgery in patients with ME secondary to retinal detachment silicone oil filling after anti-VEGF injection,while there was no significant difference in GCC thickness in the hormone injection group compared with that before surgery.3.At 1 month after surgery,the RNFL thickness in the nasal region of the retinal disc of patients with ME secondary to retinal detachment silicone oil filling was thinner after anti-VEGF injection than before surgery,while there was no significant difference in the RNFL thickness of the retinal disc of patients in the hormone-injected group compared with that before surgery. |
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