Internal Limiting Membrane Peeling During Vitrectomy for Diabetic Vitreous Hemorrhage

Rush, Ryan B; Penella, Agustin Del Valle; Reinauer, Robert M; Rush, Sloan W; Bastar, Pedro Gomez

doi:10.1097/iae.0000000000002976

Cited by 14 publications

(22 citation statements)

References 19 publications

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“…Studies show advantages in the eyes undergoing vitreoretinal surgery with additional ILM peeling in comparison to those eyes without ILM peeling. [ 21 22 ] These advantages include decrease in epiretinal membrane formation, macular edema, and need for additional surgeries postoperatively. [ 21 22 ] Additionally, ILM peeling helps in identifying second membranes in complex detachments, and ensures completeness of the PVD induction.…”

Section: Discussionmentioning

confidence: 99%

“…[ 21 22 ] These advantages include decrease in epiretinal membrane formation, macular edema, and need for additional surgeries postoperatively. [ 21 22 ] Additionally, ILM peeling helps in identifying second membranes in complex detachments, and ensures completeness of the PVD induction. In our series, intraoperative BBG-assisted ILM peeling was done in all the eyes.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features and surgical outcomes of complications of proliferative diabetic retinopathy in young adults with type 1 diabetes mellitus versus type 2 diabetes mellitus - A comparative observational study

Baliga

Kumar

Babu

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To evaluate the clinical profile, visual outcomes, and complications among young adult patients with type 1 diabetes mellitus (insulin-dependent DM-T1DM) in comparison with patients with type 2 diabetes mellitus (T2DM) undergoing vitrectomy for complications of proliferative diabetic retinopathy (PDR). Methods: A retrospective review of patients between 18 and 45 years with T1DM undergoing vitrectomy for complications of PDR between June 2017 and June 2019, with a minimum follow-up of 12 months. Consecutive patients between 30 and 45 years with type 2 diabetes (non-insulin-dependent DM-T2DM) who underwent vitrectomy for the same indications were retrospectively enrolled as the control group. Results: There were 42 eyes (28 patients) in the T1DM group and 58 eyes (47 patients) in the T2DM group. The average age at operation was 35.9 ± 6.88 years and 39.8 ± 3.03 years, respectively ( P < 0.001). At the end of follow-up, the mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 1.53 ± 0.55 to 1.30 ± 0.93 ( P value 0.07) in the T1DM group and from 1.59 ± 0.46 to 1.00 ± 0.78 in the T2DM group ( P = 0.0001). The rate of the primary and final reattachment was 76.2% and 88.1% in the T1DM group and 84.5% and 96.6% in the T2DM group. Preoperative macular tractional retinal detachment (MTRD) and neovascular glaucoma (NVG) in both the groups, chronic kidney disease (CKD) and lack of preoperative Pan retinal photocoagulation (PRP) in the T1DM group, hypertension (HTN) and, resurgery in the T2DM group, were risk factors for poor vision at the final follow-up. Conclusion: The visual and anatomic outcomes were poorer in the T1DM patients which could be due to the longer duration of diabetes with worse glycemic control, associated comorbidities like CKD, and a higher incidence of MTRD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical features and surgical outcomes of complications of proliferative diabetic retinopathy in young adults with type 1 diabetes mellitus versus type 2 diabetes mellitus - A comparative observational study

Baliga

Kumar

Babu

et al. 2021

Indian Journal of Ophthalmology

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“…The type of surgical instrumentation and use of bimanual techniques are extremely surgeon-dependent and hence no consensus was reached on these aspects. Despite recent evidence suggesting ILM peeling to be beneficial for all diabetic vitrectomies,[ 23 ] our expert panel did not recommend it in the absence of epiretinal membranes or taut posterior hyaloid face. This may be because the ILM in diabetic eyes appears more friable, is more ischemic, difficult to grasp, is therefore technically more challenging to peel, and is often removed piecemeal.…”

Section: Discussionmentioning

confidence: 68%

A Delphi method based consensus statement for surgical management of proliferative diabetic retinopathy in India

Sindal

Sengupta

Shanmugam

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To derive consensus statements for surgical management of proliferative diabetic retinopathy (PDR) for vitreoretinal (VR) surgeons. Methods: Thirteen prolific VR surgeons representing all regions of India were invited to participate in a 42-point questionnaire based on the Delphi methodology describing various surgical scenarios commonly encountered in PDR. Consensus was derived using predefined robust analytics. Scenarios that returned a moderate consensus in round 1 were taken to round 2 as per the Delphi methodology. After considering all inputs, the final consensus criteria were developed. Results: A strong consensus was derived about waiting for 4 weeks before considering vitrectomy. In treatment-naïve eyes with fresh vitreous hemorrhage (VH), the wait time was slightly shorter for extramacular tractional retinal detachment (2–4 weeks) and longer (4–6 weeks) for eyes treated previously with laser or anti-VEGF agents. The expert panel recommended using preoperative anti-VEGF only in eyes with large membranes requiring extensive dissection. For post vitrectomy VH, while a conservative approach was recommended for the first episode of VH, experts recommended immediate vitreous lavage for recurrent episodes of VH. In eyes with iris neovascularization, the panel recommended immediate anti-VEGF injection followed by early vitreous lavage in nonresponsive eyes. A strong consensus was derived for stopping antiplatelet agents before surgery, while there was only a moderate consensus for performing vitrectomy for recalcitrant macular edema unresponsive to anti-VEGF injections in the absence of traction. Conclusion: This study provides valuable consensus on managing the different scenarios encountered during surgical management of PDR and should help guide the VR surgeons in clinical decision-making.

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“…This is distinct from one of the features of severe non-proliferative DR (NPDR), where intraretinal microvascular abnormalities (IRMA) do not extend into the vitreous [8]. Important causes of vision loss in eyes with PDR include vitreous haemorrhage and tractional retinal detachment [9,10].…”

Section: Introductionmentioning

confidence: 98%

Developments in Non-Invasive Imaging to Guide Diagnosis and Treatment of Proliferative Diabetic Retinopathy: A Systematic Review

Bowditch

Chang

Mehta

2021

IJTM

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Diagnosis and management of proliferative diabetic retinopathy are reliant upon retinal imaging. A systematic literature review of non-invasive imaging to guide diagnosis and treatment of proliferative diabetic retinopathy was performed. There is a trend of moving away from invasive (e.g., fundus fluorescein angiography) to non-invasive (e.g., wide-field optical coherence tomography (OCT), OCT angiography and colour fundus photography) imaging modalities to allow for more objective assessments that can be readily repeated in a time-efficient manner without compromising patient safety. Such quantitative assessments generating large amounts of data could benefit from artificial intelligence approaches to aid clinical decision making. These non-invasive imaging modalities continue to improve both in terms of the quality of image acquisition and progress in image interpretation. It is important that newer non-invasive imaging modalities are appropriately validated in large-scale prospective observational studies or randomised clinical trials.

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Internal Limiting Membrane Peeling During Vitrectomy for Diabetic Vitreous Hemorrhage

Abstract: Intraoperative details during PPV. Means (95% confidence intervals). *Suprachoroidal hemorrhage.

Cited by 14 publications

References 19 publications

Clinical features and surgical outcomes of complications of proliferative diabetic retinopathy in young adults with type 1 diabetes mellitus versus type 2 diabetes mellitus - A comparative observational study

Clinical features and surgical outcomes of complications of proliferative diabetic retinopathy in young adults with type 1 diabetes mellitus versus type 2 diabetes mellitus - A comparative observational study

A Delphi method based consensus statement for surgical management of proliferative diabetic retinopathy in India

Developments in Non-Invasive Imaging to Guide Diagnosis and Treatment of Proliferative Diabetic Retinopathy: A Systematic Review

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