Long-Term Follow-Up of Vitrectomy for Diffuse Nontractional Diabetic Macular Edema

Kumagai, Kazuyuki; Furukawa, Masao; Ogino, Nobuchika; Larson, Eric; Iwaki, Masayoshi; Tachi, Naoko

doi:10.1097/iae.0b013e31819c632f

Cited by 102 publications

(96 citation statements)

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“…Other studies suggested that vitrectomy with and without internal limiting membrane peeling may provide anatomic and visual benefit in eyes with diffuse, nontractional, unresponsive DME refractory to laser photocoagulation [193][194][195]. Best-corrected visual acuity continued to improve until 1 year postoperatively and is maintained in the long term [194,195]. The preoperative best-corrected visual acuity was the best prognostic factor for final best-corrected visual acuity [194,195].…”

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confidence: 81%

“…However, they suggested the need for larger follow-ups and larger series to confirm these findings. Other studies suggested that vitrectomy with and without internal limiting membrane peeling may provide anatomic and visual benefit in eyes with diffuse, nontractional, unresponsive DME refractory to laser photocoagulation [193][194][195]. Best-corrected visual acuity continued to improve until 1 year postoperatively and is maintained in the long term [194,195].…”

mentioning

confidence: 81%

“…Best-corrected visual acuity continued to improve until 1 year postoperatively and is maintained in the long term [194,195]. The preoperative best-corrected visual acuity was the best prognostic factor for final best-corrected visual acuity [194,195]. On the other hand, other studies showed that the benefits of vitrectomy for DME in terms of visual acuity and macular thickness were limited to patients who exhibited signs of macular traction, either clinically and/or on optical coherence tomography [196][197][198][199].…”

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confidence: 93%

“…Several studies reported that there was no difference in the absorption rate of macular edema or the functional outcome after vitrectomy with or without internal limiting membrane peeling [194,200,201].…”

Section: Vitrectomy For Persistent Diffuse Dmementioning

confidence: 99%

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Pathophysiology and management of diabetic retinopathy

El‐Asrar¹,

Al-Mezaine

Ola

2009

Expert Review of Ophthalmology

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Diabetic retinopathy remains a major cause of worldwide preventable blindness. In this review, we evaluate the recent advances in understanding the molecular mechanisms of diabetic retinopathy, highlight the current management of diabetic retinopathy and new therapeutic approaches, and discuss the range of potential future therapeutic strategies in order to combat the disease. The microvasculature of the retina responds to hyperglycemia through a number of biochemical changes, including the activation of PKC, increased advanced glycation endproducts formation, polyol pathway and oxidative stress, and activation of the renin-angiotensin system. There is an accumulating body of evidence that inflammation and neurodegeneration play a prominent role in the pathogenesis of diabetic retinopathy. Strict metabolic control, tight blood pressure control, laser photocoagulation and vitrectomy remain the standard care for diabetic retinopathy. Emerging therapies include intravitreal triamcinolone or anti-VEGF agents, ruboxistaurin, renin-angiotensin system blockers, fenofibrate, islet cell transplantation, PPAR-g agonists and intravitreal hyaluronidase. However, more randomized, controlled clinical trials are required to clarify their role alone or in combination. Learning objectivesUpon completion of this activity, participants should be able to:• Identify factors that contribute to the development of diabetic retinopathy Medscape: Continuing Medical Education OnlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of MedscapeCME and Expert Reviews Ltd. MedscapeCME is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. MedscapeCME designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at http://cme.medscape.com/CME/expertreviews; (4) view/print certificate. For reprint orders, please contact reprints@expert-reviews.comExpert Rev. Ophthalmol. 4(6), (2009) 628Review Abu El-Asrar, Al-Mezaine & Ola CME Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and remains one of the leading causes of blindness worldwide among adults aged 20-74 years. The two most important visual complications of DR are diabetic macular edema (DME) and proliferative DR (PDR). The prevalence of DR increases with the duration of diabetes, and nearly all people with Type 1 diabetes, and more than 60% of those with Type 2, have some retinopathy after 20 years. In the Wisconsin Epide...

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confidence: 81%

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confidence: 81%

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confidence: 93%

Section: Vitrectomy For Persistent Diffuse Dmementioning

confidence: 99%

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Pathophysiology and management of diabetic retinopathy

El‐Asrar¹,

Al-Mezaine

Ola

2009

Expert Review of Ophthalmology

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“…Several studies have reported that PPV was able to effectively improve ME and visual acuity in some, but not all, cases of DME [17,18,19,20,21,22,23,24,25]. Some of these studies have also demonstrated that systemic risk factors are important for the prognosis of DME after PPV [18,24].…”

Section: Introductionmentioning

confidence: 99%

Systemic Factors Influence the Prognosis of Diabetic Macular Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling

et al. 2012

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Background: To evaluate the prognostic factors for the best-corrected visual acuity (BCVA) and foveal average retinal thickness after vitrectomy with internal limiting membrane (ILM) peeling for diabetic macular edema. Design: Retrospective, single-center study. Participants: This study involved 31 eyes of 27 patients who had undergone vitrectomy with ILM peeling between January 2005 and March 2008. Methods: Relationships between preoperative systemic or ocular factors and BCVA or foveal average retinal thickness before and 6 months after the operation were evaluated. Main Outcome Measures: BCVA and foveal average retinal thickness before and 6 months after the operation. Results: The mean logarithm of the minimum angle of resolution improved from 0.84 ± 0.64 (mean ± standard deviation) preoperatively to 0.64 ± 0.38 six months postoperatively (p = 0.393). Foveal average retinal thickness significantly improved from 473 ± 146 µm preoperatively to 318 ± 108 µm 6 months after the operation (p < 0.0001). Preoperative foveal average retinal thickness was significantly thicker with cardiovascular disease or cerebral infarction (p = 0.0019) or cystoid macular edema (p = 0.0028), while preoperative BCVA was significantly lower when an epiretinal membrane (p = 0.042) was present. Foveal average retinal thickness at the 6-month follow-up was significantly thicker when patients had a higher body mass index (p = 0.0088), were not on dialysis (p = 0.012), or did not have proliferative diabetic retinopathy (p = 0.013). BCVA at the 6-month follow-up was significantly lower in the group with no history of diabetes treatment until diabetic retinopathy was found (p = 0.023) and in patients with a higher preoperative glycosylated hemoglobin (p = 0.033). Conclusions: Preoperatively, BCVA and foveal average retinal thickness were primarily associated with ocular factors, while they were strongly associated with systemic factors, postoperatively. Ocular factor improvements may be related to the surgical procedure.

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Vitrectomy as an Adjunct to Treat-and-Extend Anti-VEGF Injections for Diabetic Macular Edema

Maguire,

Laidlaw,

Hammond

et al. 2024

JAMA Ophthalmol

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ImportanceThere are reported benefits from vitrectomy for diabetic macular edema (DME); however, data precede anti–vascular endothelial growth therapy (VEGF) therapy, supporting a need to assess the current role of vitrectomy.ObjectiveTo determine rates of recruitment and efficacy outcomes of vitrectomy plus internal limiting membrane (ILM) peeling adjunctive to treat-and-extend (T&amp;E) anti-VEGF injections for diabetic macular edema (DME).Design, Setting, and ParticipantsThis was a single-masked, multicenter randomized clinical trial at 21 sites in the United Kingdom from June 2018 to January 2021, evaluating single eyes of treatment-naive patients with symptomatic vision loss from DME for less than 1 year. Inclusion criteria were best-corrected visual acuity (BCVA) Early Treatment Diabetic Retinopathy Study letter score greater than 35 (approximate Snellen equivalent, 20/200 or better) and central subfield thickness (CST) greater than 350 μm after 3 monthly intravitreal injections of ranibizumab or aflibercept. Data analysis was performed in July 2023.InterventionsPatients were randomized 1:1 into vitrectomy plus standard care or standard care alone and further stratified into groups with vs without vitreomacular interface abnormality. Both groups received a T&amp;E anti-VEGF injection regimen with aflibercept, 2 mg, or ranibizumab, 0.5 mg. The vitrectomy group additionally underwent pars plana vitrectomy with epiretinal membrane or ILM peel within 1 month of randomization.Main Outcomes and MeasuresRate of recruitment and distance BCVA. Secondary outcome measures were CST, change in BCVA and CST, number of injections, rate of completed follow-up, and withdrawal rate.ResultsOver 32 months, 47 of a planned 100 patients were enrolled; 42 (89%; mean [SD] age, 63 [11] years; 26 [62%] male) completed 12-month follow-up visits. Baseline characteristics appeared comparable between the control (n = 23; mean [SD] age, 66 [10] years) and vitrectomy (n = 24; mean [SD] age, 62 [12] years) groups. No difference in 12-month BCVA was noted between groups, with a 12-month median (IQR) BCVA letter score of 73 (65-77) letters (Snellen equivalent, 20/40) in the control group vs 77 (67-81) letters (Snellen equivalent, 20/32) in the vitrectomy group (difference, 4 letters; 95% CI, −8 to 2; P = .24). There was no difference in BCVA change from baseline (median [IQR], −1 [−3 to 2] letters for the control group vs −2 [−8 to 2] letters for the vitrectomy group; difference, 1 letter; 95% CI, −5 to 7; P = .85). No difference was found in CST changes (median [IQR], −94 [−122 to 9] μm for the control group vs −32 [−48 to 25] μm for the vitrectomy group; difference, 62 μm; 95% CI, −110 to 11; P = .11).Conclusions and RelevanceEnrollment goals could not be attained. However, with 47 participants, evidence did not support a clinical benefit of vitrectomy plus ILM peeling as an adjunct to a T&amp;E regimen of anti-VEGF therapy for DME.Trial Registrationisrctn.org Identifier: ISRCTN59902040

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Long-Term Follow-Up of Vitrectomy for Diffuse Nontractional Diabetic Macular Edema

Cited by 102 publications

References 50 publications

Pathophysiology and management of diabetic retinopathy

Pathophysiology and management of diabetic retinopathy

Systemic Factors Influence the Prognosis of Diabetic Macular Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling

Vitrectomy as an Adjunct to Treat-and-Extend Anti-VEGF Injections for Diabetic Macular Edema

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