Ryo Mukai1, Hidetaka Matsumoto2, Hideo Akiyama2. 1. Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-35-15 Showa-cho, Maebashi, Gunma, 371-8511, Japan. rmukai@gunma-u.ac.jp. 2. Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-35-15 Showa-cho, Maebashi, Gunma, 371-8511, Japan.
Abstract
PURPOSE: To investigate clinical outcomes of vitrectomy for intractable diabetic macular edema (DME) in which anti-vascular endothelial growth factor (anti-VEGF) agents or periocular steroid were not effective. METHODS: This retrospective study examined 27 eyes of 25 cases. The main measurements included changes in visual acuity (VA) and retinal morphology. Vitrectomies were performed using the Constellation System 25G. RESULTS: Prior to undergoing vitrectomy, patients were treated with anti-VEGF agents or periocular injection of triamcinolone acetonide. The average number of anti-VEGF agent injections was 3.1 ± 2.8. Triamcinolone was used in 15 eyes. There was no significant change in the mean logMAR best-corrected visual acuity (BCVA) between baseline and posttreatment, with values of 0.49 ± 0.29 and 0.55 ± 0.33, respectively (P = 0.31). Compared with preoperative BCVA, postoperative BCVA improved by more than two lines in 4 eyes (14%), remained the same in 17 eyes (63%), and decreased in 6 eyes (23%). Morphologically, retinal thickness improved by more than 50 μm in 16 eyes (59%), remained unchanged in 7 eyes (26%), and increased in 5 eyes (18%). Retinal edema resolved in all of the cases in which macular epiretinal membrane (ERM) or vitreomacular traction (VMT) was detected by optical coherence tomography during pretreatment. CONCLUSIONS: Vitrectomy can potentially stabilize the retinal morphology in intractable DME and is likely more effective in DME cases accompanied by ERM or VMT.
PURPOSE: To investigate clinical outcomes of vitrectomy for intractable diabetic macular edema (DME) in which anti-vascular endothelial growth factor (anti-VEGF) agents or periocular steroid were not effective. METHODS: This retrospective study examined 27 eyes of 25 cases. The main measurements included changes in visual acuity (VA) and retinal morphology. Vitrectomies were performed using the Constellation System 25G. RESULTS: Prior to undergoing vitrectomy, patients were treated with anti-VEGF agents or periocular injection of triamcinolone acetonide. The average number of anti-VEGF agent injections was 3.1 ± 2.8. Triamcinolone was used in 15 eyes. There was no significant change in the mean logMAR best-corrected visual acuity (BCVA) between baseline and posttreatment, with values of 0.49 ± 0.29 and 0.55 ± 0.33, respectively (P = 0.31). Compared with preoperative BCVA, postoperative BCVA improved by more than two lines in 4 eyes (14%), remained the same in 17 eyes (63%), and decreased in 6 eyes (23%). Morphologically, retinal thickness improved by more than 50 μm in 16 eyes (59%), remained unchanged in 7 eyes (26%), and increased in 5 eyes (18%). Retinal edema resolved in all of the cases in which macular epiretinal membrane (ERM) or vitreomacular traction (VMT) was detected by optical coherence tomography during pretreatment. CONCLUSIONS: Vitrectomy can potentially stabilize the retinal morphology in intractable DME and is likely more effective in DME cases accompanied by ERM or VMT.
Authors: Neil M Bressler; Wesley T Beaulieu; Adam R Glassman; Kevin J Blinder; Susan B Bressler; Lee M Jampol; Michele Melia; John A Wells Journal: JAMA Ophthalmol Date: 2018-03-01 Impact factor: 7.389
Authors: Jean-François Korobelnik; Diana V Do; Ursula Schmidt-Erfurth; David S Boyer; Frank G Holz; Jeffrey S Heier; Edoardo Midena; Peter K Kaiser; Hiroko Terasaki; Dennis M Marcus; Quan D Nguyen; Glenn J Jaffe; Jason S Slakter; Christian Simader; Yuhwen Soo; Thomas Schmelter; George D Yancopoulos; Neil Stahl; Robert Vitti; Alyson J Berliner; Oliver Zeitz; Carola Metzig; David M Brown Journal: Ophthalmology Date: 2014-07-08 Impact factor: 12.079