Long-term results of excision of plaque-like foveal hard exudates in patients with chronic diabetic macular oedema

Avcı, Remzi; İnan, Ümit Übeyt; Kaderli, Berkant

doi:10.1038/sj.eye.6702877

Cited by 10 publications

(8 citation statements)

References 18 publications

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“…Indeed, the presence of hard exudates is a secondary phenomenon occurring when the extracellular fluid that accumulates within the retina is reabsorbed into the retinal capillaries. 28 …”

Section: Resultsmentioning

confidence: 99%

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

Miotto¹,

Zemella²,

Gusson

et al. 2018

Journal of Ocular Pharmacology and Therapeutics

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Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.

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“…Indeed, the presence of hard exudates is a secondary phenomenon occurring when the extracellular fluid that accumulates within the retina is reabsorbed into the retinal capillaries. 28 …”

Section: Resultsmentioning

confidence: 99%

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

Miotto¹,

Zemella²,

Gusson

et al. 2018

Journal of Ocular Pharmacology and Therapeutics

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“…Few studies have specifically investigated the treatment for massive hard exudates [ 24 – 29 , 31 , 32 ]. Subretinal removal of massive submacular hard exudates has been shown to improve visual acuity [ 24 , 31 ]. However, visual improvement did not show significant differences compared to those that only received PPV.…”

Section: Discussionmentioning

confidence: 99%

“…Massive hard exudates tend to deposit in the foveal area and form fibrotic plaques, causing damage to photoreceptors with irreversible central visual loss. Although medical and surgical treatments have been proposed for enhancing the resolution of exudates [24][25][26][27][28][29][30][31][32], the disease remains a major challenge. Our previous report demonstrated that pars plana vitrectomy (PPV) with posterior hyaloid removal, focal macular endolaser, and panretinal photocoagulation (PRP) can reduce massive macular exudates [33].…”

Section: Introductionmentioning

confidence: 99%

Vitrectomy with internal limiting membrane peeling versus nonsurgical treatment for diabetic macular edema with massive hard exudates

et al. 2020

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To compare the anatomical and functional outcomes of severe diabetic macular edema (DME) with massive hard exudates managed by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or nonsurgical treatment. Methods We retrospectively reviewed 40 eyes with DME and massive hard exudates treated with either PPV with ILM peeling (vitrectomy group, 21 eyes) or nonsurgical treatment with antivascular endothelium growth factor (VEGF) and/or steroids (nonsurgical group, 19 eyes). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) and resolution of macular hard exudates were compared between the two groups. Results After treatment, CRT decreased steadily in the vitrectomy group but fluctuated in the nonsurgical group. Compared with eyes in the nonsurgical group, eyes in the vitrectomy group had better visual improvement (P < 0.05 at 6 and 12 months and the final visit) and greater decrease in CRT (P < 0.05 at 3 and 6 months and the final visit) after adjustment for baseline BCVA. Hard exudates resolved more rapidly in the vitrectomy group than in the nonsurgical group, with 94.1% versus 47.4% eyes showing significant absorption after 6 months of the treatment (P = 0.003). In the vitrectomy group, 62% eyes did not require any further injections for treating DME after the operation. Conclusions PPV with ILM peeling resulted in rapid resolution of hard exudates with significant anatomical and functional improvement in DME with massive hard exudates.

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“…Favorable results have been obtained using additional surgical approaches for DME other than vitrectomy. Avci et al 23 excised plaque-like foveal hard exudates from 11 patients with chronic DME and reported a significant long-term improvement in BCVA (logMAR) at the 3-year follow-up. Morizane et al treated diffuse DME in 20 patients using a planned foveal detachment technique.…”

Section: Discussionmentioning

confidence: 99%

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

Asahina¹,

Tachi²,

Asahina³

et al. 2017

OPTH

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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.

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Long-term results of excision of plaque-like foveal hard exudates in patients with chronic diabetic macular oedema

Cited by 10 publications

References 18 publications

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

Vitrectomy with internal limiting membrane peeling versus nonsurgical treatment for diabetic macular edema with massive hard exudates

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

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