Purpose

To report the incidence of, risk factors for, and characteristics of paracentral acute middle maculopathy (PAMM) after 25-gauge pars plana vitrectomy for proliferative diabetic retinopathy (PDR).

Design

Retrospective, consecutive, interventional case series.

Participants

Five hundred thirty eyes of 427 patients who underwent primary vitrectomy for PDR from 2013 through 2016.

Methods

The patients underwent measurement of best-corrected visual acuity (BCVA), fundus photography, and OCT before and within 2 weeks after vitrectomy. A generalized linear mixed-effects model was used to evaluate risk factors for development of PAMM.

Main Outcome Measures

The incidence, associated risk factors, and clinical characteristics of PAMM following vitrectomy, including the change in BCVA in eyes with PAMM and the distribution of PAMM as determined by en face OCT.

Results

Four hundred ninety-six eyes of 395 patients who met the eligibility criteria were evaluated. The incidence of PAMM was 3.8% (15/395) for patients and 3.6% (18/496) for eyes. Multivariate analysis showed the significant risk factors for PAMM development to be younger age (mean age, 49 years in patients and 59 years in control participants; odds ratio [OR] 0.94; 95% confidence interval [CI], 0.89–0.99; P = 0.021) and female gender (66.7% of patients and 31.3% of control participants; OR, 4.48; 95% CI, 1.57–12.6; P = 0.005). The PAMM was distributed on either side of the causative arterioles. In 14 of the 18 eyes (78%), PAMM was located within a 3-mm diameter of the fovea. In 10 eyes (56%), PAMM measured 1 disc diameter or more, and in 5 eyes (28%), PAMM measured one third disc diameter or less. No emboli were found in any eyes; however, multiple segmental arterial constrictions were confirmed during vitrectomy in 1 eye. The BCVA decreased more than 2 lines in 2 eyes (5%).

Conclusions

Paracentral acute middle maculopathy can develop after pars plana vitrectomy for PDR, especially in patients who are younger and female. Impaired blood flow in arterioles, which leads to tissue hypoxia, was associated with development of PAMM.

中文翻译：

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玻璃体切除术后中央性急性中黄斑病变治疗增生性糖尿病性视网膜病变

目的

报告在25尺pars平板玻璃体切除术治疗增生性糖尿病视网膜病变（PDR）后中心旁急性中黄斑病变（PAMM）的发生率，危险因素和特征。

设计

回顾性，连续性，介入性病例系列。

参加者

2013年至2016年，对427例接受了PDR的原发玻璃体切除术的患者的530只眼进行了研究。

方法

在玻璃体切除术之前和之后2周内，对患者进行最佳矫正视力（BCVA），眼底照相和OCT的测量。使用广义线性混合效应模型评估PAMM发展的危险因素。

主要观察指标

玻璃体切除术后PAMM的发生率，相关的危险因素和临床特征，包括PAMM眼中BCVA的变化以及通过面对面OCT确定的PAMM分布。

结果

对符合资格标准的395例患者的496眼进行了评估。患者的PAMM发生率为3.8％（15/395），眼睛为3.6％（18/496）。多因素分析表明，PAMM发展的重要危险因素是年龄较小（平均年龄：患者49岁，对照组59岁；优势比[OR] 0.94； 95％置信区间[CI]，0.89–0.99；P  = 0.021）和女性（女性为66.7％，对照组为31.3％； OR为4.48； 95％CI为1.57-12.6；P = 0.005）。PAMM分布在病因小动脉的两侧。在18眼中的14眼（78％）中，PAMM位于中央凹直径3 mm以内。PAMM在10眼（56％）中测得的椎间盘直径为1或更大，在5眼（28％）中，PAMM测量出的椎间盘直径为三分之一或更小。在任何眼睛中都没有发现栓子。但是，在玻璃体切除术中有1只眼确认了多个节段性动脉收缩。BCVA在2只眼中减少了2条以上的线（5％）。

结论

PDR平板玻璃体切除术后可发生中央旁急性中层黄斑病，尤其是在年轻和女性患者中。小动脉血流受损，导致组织缺氧，与PAMM的发展有关。