Epiretinal pathology of diffuse diabetic macular edema associated with vitreomacular traction

Gandorfer, Arnd; Rohleder, Matthias; Grosselfinger, Sabine; Haritoglou, Christos; Ulbig, Michael W.; Kampik, Anselm

doi:10.1016/j.ajo.2004.11.035

Cited by 104 publications

(70 citation statements)

References 39 publications

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“…6,7 This is of particular importance in eyes with incomplete removal of the cortical vitreous from the retina, and in eyes with vitreoschisis, such as diabetic eyes. 1,8 Third, as incomplete PVD has been shown to be associated with development of aggressive fibrovascular proliferation and macular oedema, pharmacological induction of complete PVD could prevent progression of diabetic retinopathy if given before advanced stages of diabetic eye disease, both by eliminating the scaffold for cellular proliferation and by improving retinal oxygen levels.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 In progressively blinding diseases such as diabetic retinopathy, separating the vitreous from the retina before neovascular and fibrocellular proliferation grow into the vitreous cortex would prevent advanced stages of the disease. 6,8 Finally, pharmacological vitrectomy holds the potential of improving retinal oxygen levels in hypoxic retinal diseases in a more applicable way compared with mechanical vitrectomy. 9 This is of particular importance given the increasing incidence of diabetic retinopathy in the world.…”

Section: Introductionmentioning

confidence: 99%

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Enzymatic vitreous disruption

Gandorfer

2008

Eye

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Enzymatic vitreous disruption refers to cleaving the vitreoretinal junction by enzymatic means, thereby inducing posterior vitreous detachment (PVD) and liquefaction of the vitreous gel. Several enzymes have been proposed in this respect, including chondroitinase, hyaluronidase, dispase, and plasmin. In an experimental setting, chondroitinase induced PVD and was helpful in removing epiretinal membranes but no further data have been reported yet.Hyaluronidase liquefies the vitreous as demonstrated in a phase III trial in diabetic patients with vitreous haemorrhage. Dispase induces PVD but also causes inner retinal damage and is now used as an animal model of proliferative vitreoretinopathy. Plasmin has the capability of both PVD induction and liquefaction. However, plasmin is highly unstable and not available for clinical use. Microplasmin (ThromboGenics Ltd, Dublin, Ireland) is a truncated form of human plasmin sharing the same catalytic activity like plasmin. Recombinant microplasmin is under clinical investigation in patients with vitreomacular traction. This review article reports on the current knowledge of enzymatic vitreous disruption and discusses details of the enzyme candidates in basic and clinical research terms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enzymatic vitreous disruption

Gandorfer

2008

Eye

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“…Few authors reported improvement in best-corrected visual acuity (BCVA) and level of the diabetic macular edema following PPV and removal of the ERM [11,12]. The central macular thickness was measured.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Indicators for Visual Outcomes following Surgery for Epiretinal Membrane Associated with Diabetic Patients

Al-Halafi¹

2017

AOVS

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Purpose: To evaluate the predicting factors for good VA after PPV for ERM associated with DME. Methods:The medical records 29 eyes seen in the Retina Clinic and diagnosed to have ERM associated with DME were reviewed. Investigating potential predicting factors for achieving good vision included a mean change in best-corrected visual acuity (BCVA) before and after PPV, means change in CMT before and after PPV, focal and broad attachment of ERM to the ILM, age, sex and duration of the disease.Results: In the current study, 29 eyes (19 (65.5% OD and 10 (34.5% OS) of 29 patients were recruited. The mean (SD) age of our sample was 60.8 (10.6) years, range . Comparing the mean (SD) LogMAR of preoperative and the last follow-up values, the detected difference was found to be statistically significant (0.5 (0.3), [95% CI: 0.394 -0.608]; p<0.0001). The mean (SD) OCT decreased postoperatively to 352 (128) micron, then to 313 (101.5) micron in the last followup visit assessment, where such decrease from preoperative to the last follow-up assessment was statistically significant (139.2 (92.5) micron, [95% CI: 103.311-175.046]; p<0.0001). Investigating potential predicting factors for achieving vision ≥ 20/60, patients who entered the cohort in a relatively higher age and with a better initial visual acuity were found to be more likely to achieve better postoperative vision (p= 0.016 and 0.004 for age and visual acuity respectively). Conclusion:Pars plana Vitrectomy for ERM peeling associated with DME showed a better visual outcome. Patients with good initial VA achieved a better final visual outcome. Postoperative improvement in vision is slow. OCT appearance cannot predict visual outcome.

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“…ERM formation in these situations is likely to be driven partly by hypoxic cytokine-driven tissue repair. [2][3][4] Perhaps in IMT, this also has a significant role in leading to a detrimental repair process causing ERM, and in some cases, traction. Vitrectomy increases oxygenation in the vitreous cavity, increasing the availability of oxygen to the retina and thus potentially dampening tissue repair processes, as well as improving retinal function.…”

Section: Commentmentioning

confidence: 99%

“…[2][3][4] These described pinpoint white deposits, retinal vascular sheathing, microaneurysms, and scattered retinal haemorrhages. Angiographic changes similar to our patients were seen (vascular closure, focal staining, and microaneurysms on FA; hyperfluorescence and staining along choroidal and retinal vessels on ICG).…”

Section: Commentmentioning

confidence: 99%

Retinal and choroidal angiopathy and electrophysiological disturbance in a case of amyloid AA

Cheung

Cheng

Farzavandi

2009

Eye

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Sir, Retinal and choroidal angiopathy and electrophysiological disturbance in a case of amyloid AAThe common ocular manifestations of amyloidosis include deposition in the ocular adnexa, conjunctiva, cornea, glaucoma, and vitreous.1 Retinal and choroidal involvement is rare. Case reportA 35-year-old woman complained of progressive nyctalopia. She had previously been diagnosed of secondary AA amyloidosis affecting her kidneys, bone marrow, thyroid gland, and colon (confirmed on biopsy). Despite extensive investigations no underlying disease was identified.Her vision was 6/6 in each eye. Ocular adnexae, anterior segments, and intraocular pressures were normal. Fundoscopy showed widespread small drusenlike white deposits, diffuse pigmentary changes, and microaneurysms ( Figure 1). Autofluorescence imaging showed a diffuse speckled pattern ( Figure 2a). Fluorescein angiography (FA) showed multiple microaneurysms ( Figure 2b). Indocyanine green (ICG) angiography showed dilated large choroidal vessels with variable calibre, and hyperfluorescence and staining along retinal and choroidal vessels (Figure 2c and d). OCT showed normal foveal thickness. Electrophysiological testing suggested maculopathy (reduced P50 on pattern ERG; increased latency from central and peripapillary rings from both eyes on multifocal ERG) (Figure 3a). Full-field ERG showed decreased and delayed scotopic and photopic responses with borderline maximal responses, suggesting generalized photoreceptor dysfunction (Figure 3b). CommentOnly a few cases of retinal changes have been described in FAP.2-4 These described pinpoint white deposits, retinal vascular sheathing, microaneurysms, and scattered retinal haemorrhages. Angiographic changes similar to our patients were seen (vascular closure, focal staining, and microaneurysms on FA; hyperfluorescence and staining along choroidal and retinal vessels on ICG).Although the fundal changes could potentially be due to an underlying disease causing the secondary amyloid, they are strikingly similar to those described in FAP and amyloid AL. We propose that the changes result from amyloid deposition in the choroidal and retinal vasculature, which causes ischaemia and further photoreceptor and macular dysfunction. The microaneurysms and pigmentary changes are likely the result of retinal ischaemia. The pinpoint white deposits are similar in appearance to drusen and probably reflect amyloid deposition within the retina, resulting in the speckled AF pattern. Indeed Ab amyloid has been identified in drusen and may have a role in the pathogenesis of age-related macular degeneration. 5These new findings may help in further understanding

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Epiretinal pathology of diffuse diabetic macular edema associated with vitreomacular traction

Cited by 104 publications

References 39 publications

Enzymatic vitreous disruption

Enzymatic vitreous disruption

Prognostic Indicators for Visual Outcomes following Surgery for Epiretinal Membrane Associated with Diabetic Patients

Retinal and choroidal angiopathy and electrophysiological disturbance in a case of amyloid AA

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