Influence of Vitrectomy Surgery on the Integrity of Outer Retinal Layers in Diabetic Macular Edema

Uji, Akihito; Murakami, Tomoaki; Suzuma, Kiyoshi; Yoshitake, Shin; Shigeta, Ayako; Ghashut, Rima; Fujimoto, Masahiro; Yoshimura, Nagahisa

doi:10.1097/iae.0000000000001519

Cited by 14 publications

(10 citation statements)

References 40 publications

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“…In the studies of Michalewska et al [13] and Iglicki et al [16,30], the importance of early PPV surgery was emphasized as it achieved favorable visual and anatomic results in treatment-naive DME patients. As has been stated previously, functional achievements could fall behind anatomic improvements due to outer retinal layer damage and photoreceptor disruption as a result of chronic DME [35,36]. Our patients had already received medical and/or laser treatments, and their mean BCVA gain was 0.15 logMAR at the end of the follow-up.…”

Section: Discussionmentioning

confidence: 59%

Evaluation of Macular Changes in the Long Term after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema

Günay

Erdoğan

2021

Ophthalmologica

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Aim: To evaluate long term macular changes following pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for diabetic macular edema (DME) Methods: Forty eligible eyes of 37 patients were included in this retrospective study. Best corrected visual acuity (BCVA), central macular thickness (CMT) and 5-mm macular volume (5-MV) were examined preoperatively and at postoperative 1st, 2nd, 3rd, 6th, 12th, 24th months and final visits. Response to surgical treatment was considered as recurrence, reincrease and recovery of DME based on macular changes. Results: Mean follow-up time was 51.1±19.0 months following surgery. Recurrence (n=5) and reincrease (n=17) of DME was observed in 22 eyes (55%) and additional treatments were applied. Recovery of DME was observed in 18 eyes (45%). Preoperative and final visit mean BCVAs (logMAR) were 1.08±0.37 and 0.93±0.45, respectively (p=0.02). Preoperative and final visit mean CMTs were 514.74±155.65 µm and 281.87±112.58 µm, respectively (p<0.001). The 5-MV significantly decreased following surgery (8.18±1.57 mm3 to 6.52±1.39 mm3) (p<0.001). DME was present in 12 eyes (%30) at final visit. Conclusion: Although PPV with ILM peeling had an efficacy in DME management, this effect tends to decrease over time such that considerable amount of patients required additional treatment.

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Section: Discussionmentioning

confidence: 59%

Evaluation of Macular Changes in the Long Term after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema

Günay

Erdoğan

2021

Ophthalmologica

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“…This was followed by binarization with intensity thresholding using Otsu’s thresholding method for automatic binarization-level decisions. 28 …”

Section: Quantitative Measurementsmentioning

confidence: 99%

Conjunctival and Intrascleral Vasculatures Assessed Using Anterior Segment Optical Coherence Tomography Angiography in Normal Eyes

Akagi

Uji

Huang

et al. 2018

American Journal of Ophthalmology

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“…When PPV is used as a ‘rescue’ procedure, treatment results are limited due to existing damage to the outer retina layers and the external limiting membrane. [ 21 , 25 , 26 ] The DRCR.net investigated the benefit of PPV in cases of DME with vitreomacular traction. [ 27 ]…”

Section: Introductionmentioning

confidence: 99%

Biomarkers and predictors for functional and anatomic outcomes for small gauge pars plana vitrectomy and peeling of the internal limiting membrane in naïve diabetic macular edema: The VITAL Study

Iglicki

Lavaque²,

Ozimek

et al. 2018

PLoS ONE

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PurposeWe aimed to investigate biomarkers and predictive factors for visual and anatomical outcome in patients with naïve diabetic macular edema (DME) who underwent small gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling as a first line treatment.DesignMulticenter, retrospective, interventional study.Participants120 eyes from 120 patients with naïve DME treated with PPV and ILM peeling with a follow up of 24 months.MethodsChange in baseline best corrected visual acuity (BCVA) and central subfoveal thickness (CST) 1, 6, 12 and 24 months after surgery. Predictive value of baseline BCVA, CST, optical coherence tomography (OCT) features (presence of subretinal fluid (SRF) and photoreceptor damage), and time between DME diagnosis and surgery. Additional treatment for DME needed. Intra- and post-operative complications (cataract rate formation, increased intraocular pressure).Main outcome measuresThe correlation between baseline characteristics and BCVA response (mean change from baseline; categorized improvement ≥5 or ≥10; Early Treatment Diabetic Retinopathy Study (ETDRS) letters) 12 and 24 months after surgery.ResultsMean BCVA was 0.66 ± 0.14 logMAR, 0.52 ± 0.21 logMAR, and 0.53 ± 0.21 logMAR (p<0.001) at baseline, 12 and 24 months, respectively. Shorter time from DME diagnosis until PPV (OR: 0.98, 95% CI: 0.97–0.99, p<0.001) was a predictor for good functional treatment response (area under the curve 0.828). For every day PPV is postponed, the patient’s chances to gain ≥5 letters at 24 months decrease by 1.8%.Presence of SRF was identified as an anatomical predictor of a better visual outcome, (OR: 6.29, 95% CI: 1.16–34.08, p = 0.033). Safety profile was acceptable.ConclusionsOur results reveal a significant functional and anatomical improvement of DME 24 months after primary PPV, without the need for additional treatment. Early surgical intervention and presence of SRF predict good visual outcome. These biomarkers should be considered when treatment is chosen.

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Influence of Vitrectomy Surgery on the Integrity of Outer Retinal Layers in Diabetic Macular Edema

Abstract: Pars plana vitrectomy might be effective for resolution of hyperreflective foci in outer retinal layers. Parallelism is a potential marker for localization of hyperreflective foci and useful as a predictive factor for postoperative visual acuity.

Cited by 14 publications

References 40 publications

Evaluation of Macular Changes in the Long Term after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema

Evaluation of Macular Changes in the Long Term after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema

Conjunctival and Intrascleral Vasculatures Assessed Using Anterior Segment Optical Coherence Tomography Angiography in Normal Eyes

Biomarkers and predictors for functional and anatomic outcomes for small gauge pars plana vitrectomy and peeling of the internal limiting membrane in naïve diabetic macular edema: The VITAL Study

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