Efficacy of Surgical Removal of the Internal Limiting Membrane in Diabetic Cystoid Macular Edema

Kimura, Tomio; Kiryu, Junichi; Nishiwaki, Hirokazu; Oh, Hideyasu; Suzuma, Kiyoshi; Watanabe, Dai; Kurimoto, Masafumi; Takagi, Hitoshi

doi:10.1097/00006982-200506000-00010

Cited by 51 publications

(37 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies have reported favorable results by reducing or resolving DME and improving VA following PPV combined with ILM removal [3,4,5,6,7,8,9,10,11,12]. However, anatomical outcome may not always be correlated with functional results after PPV with ILM removal.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Quantitative Assessment of Photoreceptor Layer in Eyes with Resolved Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Removal for Diabetic Macular Edema

et al. 2011

View full text Add to dashboard Cite

Background/Aims: To evaluate the correlation between visual acuity (VA) and photoreceptor integrity in eyes with resolved diabetic macular edema (DME) after pars plana vitrectomy (PPV). Methods: Eleven eyes with resolved macular edema following PPV with internal limiting membrane removal for DME were included in this retrospective study. The integrity of the external limiting membrane (ELM) and inner and outer segments (IS/OS) of the photoreceptor junction was evaluated by spectral domain optical coherence tomography. The main outcome measures were percentage of disrupted ELM and IS/OS lines, and correlation between VA and photoreceptor integrity. Results: The mean time after PPV was 78 ± 17 months. The mean lengths of the disrupted ELM and IS/OS lines were 223 ± 167 µm (63%) and 189 ± 175 µm (54%) in the foveola, and 900 ± 522 µm (60%) and 835 ± 582 µm (55%) in the fovea, respectively. Intact ELM and IS/OS lines were positively correlated with VA in both the fovea (p = 0.09 and p = 0.02, respectively) and foveola (p = 0.004 and p = 0.03, respectively). Linear regression analysis showed a statistically significant association of intact ELM and IS/OS lines with VA in the fovea. Disrupted ELM and IS/OS lines had a strong correlation with each other in both the fovea (r = –0.71, p = 0.013) and foveola (r = 0.81, p = 0.02). Conclusions: The integrity of the ELM and IS/OS lines was positively correlated with VA in eyes with resolved DME after PPV.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Since it has been suggested that tangential traction exerted by the internal limiting membrane (ILM) plays an important role in diabetic macular edema (DME), pars plana vitrectomy (PPV) combined with ILM removal has been performed as an effective treatment for diffuse DME [3,4,5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

Quantitative Assessment of Photoreceptor Layer in Eyes with Resolved Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Removal for Diabetic Macular Edema

et al. 2011

View full text Add to dashboard Cite

show abstract

“…1 When DR reaches an advanced stage, complications such as macular edema, vitreous hemorrhage, tractional retinal detachment, or neovascular glaucoma can be present. Diabetic macular edema (DME) is one of the common causes of visual loss, and it is normally treated by focal photocoagulation, 2, 3 pars plana vitrectomy (PPV), 4 triamcinolone acetonide, 5 and anti-vascular endothelial growth factor. 6 The best treatment for DME has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Imaging of Laser-Photocoagulated Diabetic Microaneurysm With Spectral Domain Optical Coherence Tomography

Yamada

Suzuma

Fujikawa

et al. 2013

Retina

Self Cite

View full text Add to dashboard Cite

Summary Statement: Microaneurysms were evaluated with SD-OCT before and after photocoagulation. Focal photocoagulation may be a less invasive method for treating microaneurysms and that SD-OCT is useful for evaluating the efficacy of photocoagulation. Methods: In 13 eyes of diabetic patients who underwent focal photocoagulation for clinically significant macular edema, microaneurysms were evaluated before and immediately, 1 month and 2 months after photocoagulation with SD-OCT.The microaneurysms were also evaluated by fluorescein angiography and color fundus photography. The patients underwent focal photocoagulation for microaneurysm.Results: The microaneurysms before photocoagulation in SD-OCT were observed as circular or elliptical structures with hyper-reflective foci within vessel walls. Immediately after photocoagulation, the microaneurysms were changed to indistinct lesions with hyper-reflectivity around the microaneurysms. Acoustic shadows developed on the choroidal side of the microaneurysms. If photocoagulation for microaneurysms was appropriately done, retinal changes were limited to within the inner-retina around the microaneurysms and no changes were observed in retinal pigment epithelium. Within 2 months after 5 photocoagulation, the microaneurysms changed into fine scars, and the retinal structure normalized. Average retinal thickness of the fovea was 432±70 μm before the procedure, but reduced to 373±84 μm at 2 months post-surgery.Conclusions: Focal photocoagulation may be a less invasive method for treating microaneurysms and that SD-OCT is useful for evaluating the efficacy of photocoagulation.

show abstract

“…Most reports of ILM peeling for diffuse DME included eyes undergoing initial vitrectomy, and only a few reports included eyes that have had a previous vitrectomy. The largest study of the latter was reported by Kimura et al [11]. They reported results of ILM peeling for DME in 21 eyes, of which 9 had previous vitrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…All 9 of these eyes had resolution of diabetic cystoid macular edema and improvement in visual acuity. Although Kimura et al [11] performed histopathology, it was only to confirm the presence of the ILM and no other pathological data was reported. These eyes may have had a taut ILM, similar to our cases.…”

Section: Discussionmentioning

confidence: 99%

Taut Internal Limiting Membrane Causing Diffuse Diabetic Macular Edema after Vitrectomy: Clinicopathological Correlation

et al. 2011

View full text Add to dashboard Cite

Aims: To describe 2 cases of diffuse diabetic macular edema (DME) after diabetic vitrectomy caused by a taut internal limiting membrane (ILM), with clinicopathological correlation. Methods: Interventional case series with immunohistochemical analysis. Results: Two patients were referred for unresponsive diffuse DME after pars plana vitrectomy with removal of the posterior hyaloid. Clinically, a taut ILM was noted over the fovea, and its removal resulted in rapid and long-term resolution of the edema, confirmed by optical coherence tomography with visual acuity improvement. Histopathology with immunostaining revealed a segment of ILM with an inner monolayer of cytokeratin-positive (retinal pigment epithelial cells) and/or glial fibrillary acidic protein-positive cells with smooth muscle actin immunoreactivity. Conclusions: A taut ILM can cause diffuse DME after vitrectomy, and its removal can restore the normal foveal contour and improve visual acuity. Tangential tractional forces from contractile cells propagated across the fovea via the ILM appear to be the etiology.

show abstract

Efficacy of Surgical Removal of the Internal Limiting Membrane in Diabetic Cystoid Macular Edema

Abstract: Surgical removal of the ILM might be an effective procedure for reducing CME in patients with diabetes. A prospective, randomized, controlled study is necessary to further evaluate the efficacy of the procedure.

Cited by 51 publications

References 14 publications

Quantitative Assessment of Photoreceptor Layer in Eyes with Resolved Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Removal for Diabetic Macular Edema

Quantitative Assessment of Photoreceptor Layer in Eyes with Resolved Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Removal for Diabetic Macular Edema

Imaging of Laser-Photocoagulated Diabetic Microaneurysm With Spectral Domain Optical Coherence Tomography

Taut Internal Limiting Membrane Causing Diffuse Diabetic Macular Edema after Vitrectomy: Clinicopathological Correlation

Contact Info

Product

Resources

About