Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema

Yamamoto, Tohru; Hitani, Koichiro; Tsukahara, Itsuro; Yamamoto, Shuichi; Kawasaki, Ryo; Yamashita, Hidetoshi; Takeuchi, Shinobu

doi:10.1016/s0002-9394(02)01819-6

Cited by 127 publications

(78 citation statements)

References 20 publications

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“…4 This basement membrane scaffolding may play a role in the development of persistent macular oedema and in the proliferation, or reproliferation of ERM. 5 Earlier studies have suggested ILM peeling as an adjunct to macular surgery may improve surgical outcomes in certain macular diseases, such as macular holes, [6][7][8] epiretinal membranes, 9,10 and diabetic macular oedema; [11][12][13] however, the effect of ILM peeling in the prevention of postoperative ERM remains unknown in diabetic active FVP, which is characterized by a strong proproliferative biological environment. 14,15 To answer this question, we conducted a prospective, comparative case series study to evaluate the visual and functional outcomes of vitrectomy, with or without ILM removal, in eyes with progressive FVP.…”

Section: Introductionmentioning

confidence: 99%

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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Objective To evaluate the anatomical and functional results of internal limiting membrane (ILM) peeling during pars plana vitrectomy for fibrovascular proliferation (FVP) in diabetic retinopathy. Methods The study was a prospective comparative case series in design. Patients undergoing pars plana vitrectomy for mild to moderate diabetic FVP were divided into either Group 1: vitrectomy only, or Group 2: further ILM peeling in the macular area. Best-corrected visual acuity, fundus examination, and optical coherence tomography (OCT) were conducted at 3 and 6 months postoperatively. Results There were 26 eyes of 25 patients in Group 1 (non-ILM peeling) and 23 eyes of 22 patients in Group 2 (ILM peeling). At 6 months postoperatively, OCT-identifiable epiretinal membrane (ERM) was found in 10 of 26 eyes (38.5%) in Group 1and 0 of 23 eyes in Group 2 (P ¼ 0.001) and six eyes (23.1%) in Group 1 developed biomicroscopic ERM, whereas no patients in Group 2 had ERM (P ¼ 0.02) at 6 months. OCT identifiable ERM correlated significantly with central macular thickness (r ¼ À0.58, Po0.001), the presence of intraretinal cystic space (r ¼ 0.60, Po0.001), and fovea depression reappearance (r ¼ 0.36, P ¼ 0.008). Factors associated with poor visual outcome were macular detachment (Po0.001) and non-ILM peeling (P ¼ 0.004). Conclusions This pilot study suggests that ILM peeling during vitrectomy for diabetic fibrovascular proliferative membranes may minimize postoperative ERM formation and improve visual prognosis.

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Section: Introductionmentioning

confidence: 99%

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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“…They attributed the better results to the removal of all elements that could exert traction on the retina by the ILM removal. However, there are other studies that report that pars plana vitrectomy alone can reduce the postoperative retinal thickness (edema) in 46–100% of the eyes with diabetic macular edema [4,5,6,7]. Tachi and Ogino [8] reported that pars plana vitrectomy without ILM peeling was efficacious in eyes with diabetic macular edema and even in those without a thickened posterior hyaloid membrane.…”

Section: Introductionmentioning

confidence: 99%

Vitrectomy for Diabetic Macular Edema with and without Internal Limiting Membrane Removal

et al. 2005

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Purpose: To compare the efficacy of surgically removing or not removing the internal limiting membrane (ILM) during pars plana vitrectomy on the visual acuity and retinal thickness in eyes with diabetic macular edema. Methods: A prospective, case-control study was carried out on 30 eyes of 29 patients undergoing pars plana vitrectomy for diabetic macular edema. Fifteen eyes underwent pars plana vitrectomy with ILM removal and 15 eyes without ILM removal. Results: In 7 of 15 eyes (47%) in the ILM-removed group, the visual acuity improved by 0.2 or more log of the minimum angle of resolution (log MAR) units and remained unchanged in 8 eyes (53%). In the ILM-preserved group, the final visual acuity improved in 9 of 15 eyes (60%) and remained unchanged in 6 eyes (40%). The difference in visual acuity between the two groups after 11 months the surgery was not significant (Fisher’s exact test, p = 0.4938). In the ILM-removed group, the final retinal thickness decreased by more than 20% of the preoperative retinal thickness in 12 of 15 eyes (80%), remained unchanged in 2 of 15 eyes (13%), and increased in 1 of 15 eyes (7%). In the ILM-preserved group, the final retinal thickness decreased in 13 of 15 eyes (87%) and remained unchanged in 2 of 15 eyes (23%). The differences in the changes in the retinal thickness between the two groups were not statistically significant (Fisher’s exact test, p = 0.5945). Conclusion: Vitrectomy in eyes with diabetic macular edema without ILM removal was as effective in reducing the retinal thickness and improving the visual acuity as eyes with ILM removal. We conclude that ILM need not be removed to treat eyes with diabetic macular edema.

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“…Previous investigators reported a positive impact of pars plana vitrectomy in DME [25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64]. Vitrectomy with removal of the premacular posterior hyaloid may resolve the DME and improve vision in patients who previously failed to respond to conventional laser treatment.…”

Section: Pars Plana Vitrectomymentioning

confidence: 99%

“…In the following years, numerous retrospective studies have shown the advantage of vitrectomy and removal of the posterior hyaloid on morphologic and functional results [34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65]. Harbour et al [35], Pendergast [36] and Kaiser et al [39] evaluated the surgical results in patients with a thickened and taut posterior hyaloid membrane in combination with DME and stated that early surgical intervention may result in better visual outcome.…”

Section: Pars Plana Vitrectomymentioning

confidence: 99%

Current Treatment Approaches in Diabetic Macular Edema

Meyer¹

2007

Ophthalmologica

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Purpose: To review current treatment approaches in diabetic macular edema (DME). Methods: The underlying pathopathology, classifications and diagnostic examination techniques including fluorescein angiography, optical coherence tomography and stereoscopic biomicroscopy. Treatment modalities with focal or grid argon laser photocoagulation, pars plana vitrectomy with and without peeling of the inner limiting membrane (ILM), as well as intravitreal injections using triamcinolone acetonide or novel vascular endothelial growth factor (VEGF) inhibitors are described. Results: DME results from a series of biochemical and cellular changes, causing progressive leakage and exudation. Focal and grid photocoagulation remains the standard care for diabetic maculopathy. However, the availability of new agents raises the possibility of improvements if significant benefits can be validated in randomized clinical trials. Posterior vitreous attachments play a critical role through several mechanical or physiological mechanisms. Vitrectomy without ILM removal seems to be effective in reducing the retinal thickness and improving visual acuity. Conclusion: A proper evaluation of the vitreous and retina is fundamental to select the most appropriate treatment approach in DME. While small microaneurysms with focal DME may be treated by conventional focal photocoagulation, diffuse DME which do not respond to grid photocoagulation may benefit from intravitreal injections using triamcinolone acetonide or novel VEGF inhibitors. Eyes with DME and additional vitreous traction may benefit from pars plana vitrectomy without ILM peeling. A combination of laser, pharmacological and surgical treatment modalities may be necessary to maintain central vision in eyes with DME.

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Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema

Cited by 127 publications

References 20 publications

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Vitrectomy for Diabetic Macular Edema with and without Internal Limiting Membrane Removal

Current Treatment Approaches in Diabetic Macular Edema

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