H Takagi1, A Otani, J Kiryu, Y Ogura. 1. Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Japan.
Abstract
OBJECTIVE: To examine the efficacy of surgical removal of foveal hard exudates in diabetic macular edema and to determine the expression of vascular endothelial growth factor (VEGF) in the excised specimens. DESIGN: Cohort study. PARTICIPANTS: Seven eyes of six patients with massive subfoveal hard exudate due to diabetic macular edema were examined. The average age of the patient was 56 years (range, 46-60 years). INTERVENTION: Pars plana vitrectomy for removal of massive foveal exudates was performed. MAIN OUTCOME MEASURES: Preoperative and postoperative visual acuity and complications were recorded; immunohistochemical staining for VEGF and other cell markers for macrophage and pigment epithelial cells in excised specimens was performed. RESULTS: Postoperative best-corrected visual acuity improved by two or more lines of Snellen equivalent in five eyes (71%) (P = 0.0061). VEGF, identified by anticytokeratin and CD68 antibodies, was expressed in pigment epithelial cells and macrophages invading the hard exudates. CONCLUSION: Surgical removal of foveal hard exudates might be effective in low-vision patients with diabetic maculopathy. VEGF might play a role in the formation and persistence of foveal hard exudates in diabetic macular edema.
OBJECTIVE: To examine the efficacy of surgical removal of foveal hard exudates in diabetic macular edema and to determine the expression of vascular endothelial growth factor (VEGF) in the excised specimens. DESIGN: Cohort study. PARTICIPANTS: Seven eyes of six patients with massive subfoveal hard exudate due to diabetic macular edema were examined. The average age of the patient was 56 years (range, 46-60 years). INTERVENTION: Pars plana vitrectomy for removal of massive foveal exudates was performed. MAIN OUTCOME MEASURES: Preoperative and postoperative visual acuity and complications were recorded; immunohistochemical staining for VEGF and other cell markers for macrophage and pigment epithelial cells in excised specimens was performed. RESULTS: Postoperative best-corrected visual acuity improved by two or more lines of Snellen equivalent in five eyes (71%) (P = 0.0061). VEGF, identified by anticytokeratin and CD68 antibodies, was expressed in pigment epithelial cells and macrophages invading the hard exudates. CONCLUSION: Surgical removal of foveal hard exudates might be effective in low-visionpatients with diabetic maculopathy. VEGF might play a role in the formation and persistence of foveal hard exudates in diabetic macular edema.
Authors: Julia A Haller; Haijing Qin; Rajendra S Apte; Roy R Beck; Neil M Bressler; David J Browning; Ronald P Danis; Adam R Glassman; Joseph M Googe; Craig Kollman; Andreas K Lauer; Mark A Peters; Margaret E Stockman Journal: Ophthalmology Date: 2010-03-17 Impact factor: 12.079