Long-Term Effect of Cystotomy With or Without the Fibrinogen Clot Removal for Refractory Cystoid Macular Edema Secondary to Diabetic Retinopathy

Abstract

Purpose: To show the long-term effect of cystotomy with or without fibrinogen clot removal for refractory cystoid macular edema secondary to diabetic retinopathy.Methods: Retrospective analyses of the medical records of 30 eyes of 30 patients with refractory cystoid macular edema secondary to diabetic retinopathy who had followed up for 12 months after the surgery were performed.Results: There were 15 men and 15 women. The mean ± SD age was 68.4 ± 7.9 years. The best-corrected visual acuity (logarithm of the minimal angle of resolution) at 12 months after the surgery (0.33 ± 0.25, Snellen equivalent, 20/42) was statistically better than the preoperative best-corrected visual acuity (0.45 ± 0.33, Snellen equivalent, 20/56) (P , 0.01). The central sensitivity on microperimetry (dB) was not statistically changed between preoperatively (24.0 ± 4.9) and 12 months after the surgery (24.1 ± 4.0) (P = 0.75). The central retinal thickness on optical coherence tomography (mm) at 12 months after the surgery (300.3 ± 99.0) was statistically improved compared with the preoperative central retinal thickness (565.6 ± 198.7) (P , 0.01). During the follow-up period, cystoid macular edema relapsed in seven of 30 eyes. The preoperative cystoid cavity reflectivity on optical coherence tomography in patients with fibrinogen clot removal (n = 16) was significantly higher than that in patients without fibrinogen clot removal (n = 14) (P , 0.04). Conclusion:The cystotomy with or without fibrinogen clot removal may be a promising treatment option for refractory cystoid macular edema secondary to diabetic retinopathy.

Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy

“…Recently, Imai et al reported the effectiveness of cystotomy for long-term anatomical and functional improvements of refractory cystoid macular edema secondary to DR. However, it is necessary to accumulate many cases for the concrete conclusion of the effectiveness of cystotomy [155,156]. Overall, there is the possibility of the same risks as other vitrectomies, and care must be taken when choosing potential patients.…”

The Long-Term Effect of Cystotomy With Fibrinogen Clot Removal for a Cystoid Macular Edema Secondary to Idiopathic Macular Telangiectasia Type 1: A Case Report

“…The removed translucent mass was thought to be a fibrinogen clot based on the characteristic clinical findings, such as translucent color, irregular shape, and size (see Video, Supplemental Digital Content 1, http://links.lww.com/ICB/A122, which demonstrates the surgical process of cystotomy and en bloc removal of the fibrinogen-rich component of the cystoid lesion in this case). 6,7 The CME rapidly disappeared after surgery. Three years after the operation, the patient had best-corrected decimal visual acuity of 0.5 (Snellen equivalent, 20/40) at the last medical examination, and the CME has not recurred (Figure 2, A-F).…”

“…Surgical procedures for refractory CME that include cystotomy and en bloc removal of the fibrinogen-rich component of the cystoid lesion have been reported to improve visual acuity and the macular edema secondary to several retinal vascular disorders, such as diabetic retinopathy and retinal vein occlusion. 6,7…”

“…Surgical procedures for refractory CME that include cystotomy and en bloc removal of the fibrinogen-rich component of the cystoid lesion have been reported to improve visual acuity and the macular edema secondary to several retinal vascular disorders, such as diabetic retinopathy and retinal vein occlusion. 6,7 We herein report the case of a patient with CME secondary to MacTel Type 1, which was successfully treated by cystotomy and en bloc removal of the fibrinogen-rich component of the cystoid lesion.…”

Cystotomy with or without fibrinogen clot removal for refractory cystoid macular edema secondary to branch retinal vein occlusion

“…They reported that 7 of 22 eyes had improved vision, 13 had no change, and 2 had worsened after surgery. We recently reported that the accumulation of fibrinogen in cystoid cavities of rfCME secondary to branch retinal vein occlusion (BRVO), DR, and idiopathic macular telangiectasia type 1, and the removal of fibrinogen clots with cystotomy showed postoperative functional and anatomical improvements 7 , 8 . These outcomes suggest the effectiveness of cystotomy and fibrinogen clot removal for rfCME secondary to BRVO, but the details have not been investigated.…”