Six-month postoperative outcomes of intraoperative OCT-guided surgical cystotomy for refractory cystoid macular edema in diabetic eyes

Abstract

PurposeThis study evaluated the outcomes of surgical cystotomy for recurrent diabetic cystoid macular edema (CME).Patients and methodsWe analyzed 20 eyes with a clinical diagnosis of diabetic retinopathy and refractory CME. Release of vitreoretinal adhesion, epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling and cystotomy guided by intraoperative optical coherence tomography (iOCT) were performed in every patient. Pars plana vitrectomy was also performed in 17 patients, 11 of whom also underwent lensectomy and intraocular lens implantation. Central retinal thickness (CRT), central minimum macular thickness (CMMT), macular volume (MV) and best-corrected visual acuity (BCVA) were compared preoperatively and 1 and 6 months post surgery.ResultsCRT, CMMT and MV significantly improved 1 and 6 months post surgery in each group (P<0.01). Significant improvements in BCVA were only observed 6 months post surgery (P<0.01). No intra- or postoperative complications were observed in all patients.ConclusionCRT, CMMT, MV and BCVA significantly improved 6 months following surgical cystectomy. This implies that iOCT-guided cystotomy could be another treatment option for refractory CME in diabetic eyes.

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review

“…MI-OCT allows surgeons to perform cystotomy for recurrent diabetic cystoid macular oedema, an experimental treatment proposed by Asahina et al [ 85 ]. At six months of follow-up, central retinal thickness, macular volume, and best-corrected visual acuity improved significantly in 13 eyes (65%) out of 20 affected by recurrent diabetic cystoid macular oedema treated with ERM and ILM peeling and cystotomy [ 85 ].…”

Surgical cystotomy for refractory diabetic cystoid macular edema

“…However, in the 1999 paper by Tachi et al,4 the visual acuity remained same or worsened after surgery in 17 of 22 eyes. CME puncture for long-standing refractory CME resulted in resolution of CME without a significant improvement in visual acuity in the study by Singh et al5 In the study by Asahina et al,1 18 of 20 eyes had maintained or improved visual acuity after surgery. Thus, cystotomy adds to the limited treatment options for resistant diabetic CME.…”

“…I read with interest the article on cystotomy for refractory diabetic cystoid macular edema (CME) by Asahina et al1 Intraoperative optical coherence tomography (OCT) (RESCAN 700; Carl Zeiss Meditec AG, Jena, Germany) is a new interesting addition to ophthalmic surgeons’ armamentarium 2. Few aspects regarding the manuscript1 need further discussion.…”

“…Few aspects regarding the manuscript1 need further discussion. 1) The exact definition of “refractory CME” needs elaboration.…”

“…It has the theoretical potential of reduced surgical trauma compared to a 27-gauge needle, and may also be used to flush the intraretinal fluid in such cases. 4) The exact role of intraoperative OCT will be more substantiated if the authors could provide a surgical video or figures showing the use of intraoperative OCT. 5) Puncture of the cystoid spaces at the macula is an innovative surgical technique 1,4. However, in the 1999 paper by Tachi et al,4 the visual acuity remained same or worsened after surgery in 17 of 22 eyes.…”