Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling

Khattab, Abdelrahman Ahmed Ali; Ahmed, Mahmoud Mohammed; Hammed, Abdullah Hussein

doi:10.51329/mehdiophthal1454

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Approximately one-third of the patients with diabetes develop DR, which is the most frequent cause of blindness in the working population aged 20 – 74 years [ 14 ]. The prevalence of DR is expected to be doubled by 2050, involving 14.6 million individuals [ 15 , 16 ]. The asymptomatic nature of DR in its early stages necessitates early detection and management before the onset of visual symptoms and the worsening of visual acuity [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Eight years’ experience in mobile teleophthalmology for diabetic retinopathy screening

Appukumran¹,

Shyamsundar²,

Agrawal³

et al. 2023

Med Hypothesis Discov Innov Ophthalmol

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Background: Screening for diabetic retinopathy in the community without compromising the routine workof ophthalmologists at hospitals is the essence of teleophthalmology. This study was aimed at investigating theefficacy of teleophthalmology practice for screening diabetic retinopathy from 2012 to 2020. It was also aimed at comparing the 2-year prevalence of camps organized by a district hospital in South India, as well as the footfall, reporting, follow-up, patient response, and diagnostic efficacy at these camps. Methods: All patients with diabetes and unexplained vision deterioration attending the mobile camp unitsunderwent non-dilated fundus photography. Patients underwent teleconsultation with the ophthalmologist atthe district hospital, and those requiring intervention were called to the district hospital. Trends were studiedfor the number of patients reporting to the hospital. Patient satisfaction was recorded based on a questionnaire. Results: A total of 682 camps were held over 8 years, and 30 230 patients were examined. Teleconsultationwas done for 12 157 (40.21%) patients. Patients requiring further investigations, intervention for diabeticretinopathy, or further management of other ocular pathologies were urgently referred to the district hospital(n= 3293 [10.89%] of 30 230 examined patients). The severity and presence of clinically significant macularedema increased significantly with an increased duration of diabetes mellitus (P < 0.001). The percentage ofteleconsultations showed an increasing trend over the years (P = 0.001). Similarly, considering trends of patientsreporting to the hospital, the attrition rate decreased over the years (P < 0.05). A total of 10 974 of 12 157(90.27%) patients who underwent teleophthalmic consultation were satisfied with the service. Conclusions: Teleconsultations over the years showed an increasing trend, and the attrition rate decreased overthe years. Teleophthalmology is achieving success in providing high-quality service, easy access to care, and inincreasing patient satisfaction. Future studies on the role of teleophthalmology for other leading preventablecauses of blindness seem possible and necessary.

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Section: Discussionmentioning

confidence: 99%

Eight years’ experience in mobile teleophthalmology for diabetic retinopathy screening

Appukumran¹,

Shyamsundar²,

Agrawal³

et al. 2023

Med Hypothesis Discov Innov Ophthalmol

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“…Pars plana vitrectomy (PPV): Although still controversial, the vitreomacular traction seems to be a relevant factor in the development and maintenance of DME [ 10 ]. Animal and clinical studies have suggested that PPV may work by reducing vitreoretinal tractions, increasing vitreal and retinal oxygenation, and cleaning the vitreous from inflammatory mediators including VEGF, representing, therefore, a rational approach in DME eyes [ 49 , 50 ].…”

Section: Diabetic Macular Edemamentioning

confidence: 99%

“…PPV can be considered in cases of DME associated with vitreomacular traction, epiretinal membranes, or the presence of proliferative diabetic retinopathy (PDR) with macular traction. Although previous authors have demonstrated the efficacy of the PPV in terms of VA gain in DME eyes with vitreomacular traction, the peeling of epiretinal or internal limiting membranes has provided structural improvements in the absence of significant VA gain [ 49 , 50 ]. Therefore, the advantages of PPV in DME patients without vitreomacular traction remain uncertain and should be considered only in cases when the response to IV anti-VEGF or steroids is unsatisfactory [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Section: Diabetic Macular Edemamentioning

confidence: 99%

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

Salvetat,

Pellegrini,

Spadea

et al. 2024

JCM

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Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion of individuals with diabetes, with the prevalence increasing with disease duration and severity. It is estimated that approximately 25–30% of diabetic patients will develop DME during their lifetime. Poor glycemic control, hypertension, hyperlipidemia, diabetes duration, and genetic predisposition are recognized as risk factors for the development and progression of DME. Although the exact pathophysiology is still not completely understood, it has been demonstrated that chronic hyperglycemia triggers a cascade of biochemical processes, including increased oxidative stress, inflammation, activation of vascular endothelial growth factor (VEGF), cellular dysfunction, and apoptosis, with breakdown of the blood-retinal barriers and fluid accumulation within the macular area. Early diagnosis and appropriate management of DME are crucial for improving visual outcomes. Although the control of systemic risk factors still remains the most important strategy in DME treatment, intravitreal pharmacotherapy with anti-VEGF molecules or steroids is currently considered the first-line approach in DME patients, whereas macular laser photocoagulation and pars plana vitrectomy may be useful in selected cases. Available intravitreal steroids, including triamcinolone acetonide injections and dexamethasone and fluocinolone acetonide implants, exert their therapeutic effect by reducing inflammation, inhibiting VEGF expression, stabilizing the blood-retinal barrier and thus reducing vascular permeability. They have been demonstrated to be effective in reducing macular edema and improving visual outcomes in DME patients but are associated with a high risk of intraocular pressure elevation and cataract development, so their use requires an accurate patient selection. This manuscript aims to provide a comprehensive overview of the pathology, epidemiology, risk factors, physiopathology, clinical features, treatment mechanisms of actions, treatment options, prognosis, and ongoing clinical studies related to the treatment of DME, with particular consideration of intravitreal steroids therapy.

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Diabetic macular edema (DME): dissecting pathogenesis, prognostication, diagnostic modalities along with current and futuristic therapeutic insights

Sakini,

Hamid,

Alkhuzaie

et al. 2024

Int J Retin Vitr

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One of the most common health concerns disturbing people within working years globally is diabetes mellitus (DM). One well-known consequence of DM is vascular damage, which can manifest as macro- and microangiopathy affecting the ocular retina. Therefore, Diabetic macular edema (DME) is a major sight-threatening complication of diabetic retinopathy (DR) worldwide. It is the most prevalent cause of significant vision impairment in diabetic patients. Long-term vision loss can be avoided by following early DME treatment guidelines in everyday life. Hence, there are various therapeutic approaches for DME management. Currently, the first-line treatment for DME is anti-VEGF family drugs, such as ranibizumab, brolucizumab, bevacizumab, and aflibercept. Nevertheless, relapses of the disease, inadequate response, and resistance during anti-VEGF therapy are still seen because of the intricate pathophysiological foundation of the disease. Consequently, there is an excellent requirement for therapeutic approaches to advance and become better at controlling diseases more satisfactorily and require fewer treatments overall. We conducted a thorough literature search in the current review to present a comprehensive overview of the primary data about the current DME therapeutic agents. We also covered the novel advances in DME management and probable future treatments being investigated and developed. This review recommended that Large clinical trials should afford sufficient evidence to support these innovative treatment modalities.

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Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling

Cited by 5 publications

References 30 publications

Eight years’ experience in mobile teleophthalmology for diabetic retinopathy screening

Eight years’ experience in mobile teleophthalmology for diabetic retinopathy screening

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

Diabetic macular edema (DME): dissecting pathogenesis, prognostication, diagnostic modalities along with current and futuristic therapeutic insights

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