Macular ischemia and outcome of vitrectomy for diabetic macular edema

Kim, Jae Hui; Kang, Se Woong; Shin, Dong Hoon; Kim, Sang Jin; Cho, Han Joo

doi:10.1007/s10384-015-0402-4

Cited by 12 publications

(7 citation statements)

References 42 publications

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“…PPV itself has been widely used to treat tractional or refractory DME (40)(41)(42)(43), which relieves DME through multiple mechanisms, including the elimination of traction factors (44), improving intravitreal oxygenation, removing pathological cytokines (such as VEGF) in the vitreous cavity, and accelerating the half-life of intravitreal cytokines (45). Whereas the low incidence of postoperative DME after PPV, there are few studies on the risk factors for postoperative DME in patients with PDR.…”

Section: Discussionmentioning

confidence: 99%

The association between different hypoglycemic regimens and postoperative diabetic macular edema after vitrectomy in the Japanese patients with proliferative diabetic retinopathy

Lei

Zhang

2022

Front. Endocrinol.

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PurposeTo study the association between different hypoglycemic regimens and postoperative diabetic macular edema (DME).MethodsA secondary analysis based on a retrospective cohort study.ResultsIn this secondary analysis, 124 eyes from patients with proliferative diabetic retinopathy (PDR) who underwent pars plana vitrectomy (PPV) between January 2008 and September 2012 were included. We found that compared with oral hypoglycemic medication, oral hypoglycemic medication plus insulin treatment revealed an insignificant relationship with postoperative DME (odds ratio [OR]=0.8, 95% confidence interval [CI]: 0.12-5.21, P=0.8167), only insulin treatment revealed a significant association with postoperative DME (OR=0.10, 95% CI: 0.01-0.84, P=0.0337) after adjusted age, sex. After adjusted age, sex, diabetes mellitus (DM) duration, glycosylated hemoglobin (HbA1c), the results did not have obvious changes (OR=0.61, 95% CI: 0.09-4.26, P=0.6187; OR=0.07, 95% CI: 0.01-0.65, P=0.0197). Furthermore, after adjusted age, sex, DM duration, HbA1c, hypertension, intraoperative retinal photocoagulation, vitreous hemorrhage, macular detachment, fibrovascular membrane, intraocular lens implantation and microincision vitrectomy surgery, the results were consistent (OR=0.66, 95% CI: 0.05-9.49, P=0.7621; OR=0.06, 95% CI: 0.00-0.81, P=0.0342). The same trend was observed in these adjusted models as well (p for trend was 0.0254, 0.0141, and 0.0311, respectively).ConclusionIn conclusion, our results of the secondary analysis should be interpreted as a significant association between insulin treatment and reduced risks of postoperative DME in Japanese PDR patients with PPV surgery, compared with oral medications. Well glycemic control with longstanding insulin therapy may be beneficial to reduce the risks of postoperative DME in PDR patients. Our investigation calls for large-scale and long-term prospective clinical studies for a full evaluation of the exact role of insulin in the progression of postoperative DME.

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Section: Discussionmentioning

confidence: 99%

The association between different hypoglycemic regimens and postoperative diabetic macular edema after vitrectomy in the Japanese patients with proliferative diabetic retinopathy

Lei

Zhang

2022

Front. Endocrinol.

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“…In this situation, vitrectomy can be an alternative treatment. Several previous studies have reported the efficacy of vitrectomy for treatment-refractory DME [10][11][12][28][29][30] . The studies agree that vitrectomy helps reduce macular thickness in refractory DME, but improvement of visual acuity after vitrectomy has been controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Four (9%) subjects did not achieve resolution of macular edema and underwent additional treatment after 3 months postoperatively. www.nature.com/scientificreports/ vitrectomy for refractory DME is beneficial in both reducing CMT and improving visual acuity [10][11][12][29][30][31] . In contrast, in a large prospective study from the Diabetic Retinopathy Clinical Research Network (DRCR.net), vitrectomy was beneficial for reducing CMT; however, its efficacy for improving visual acuity was limited 28 .…”

Section: Figurementioning

confidence: 99%

Three-year outcomes of vitrectomy combined with intraoperative dexamethasone implantation for non-tractional refractory diabetic macular edema

Hwang

Kang

Kim

et al. 2021

Sci Rep

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This retrospective, consecutive interventional study investigated the long-term clinical outcomes of combined vitrectomy with intraoperative dexamethasone implants for non-tractional refractory diabetic macular edema (DME). The study included 43 eyes from 39 participants with DME that had continued for more than 6 months despite repeated non-surgical treatment. Postoperative changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated over 3 years. A Kaplan–Meier curve was obtained for any additional non-surgical treatment, and the average number of non-surgical treatments required for DME before and after surgery was compared. Other postsurgical complications were also investigated. The logMAR BCVA improved from 0.526 ± 0.417 (20/67) preoperatively to 0.294 ± 0.374 (20/39) 3 years postoperatively (p < 0.001, generalized estimating equation). The CMT improved from 478 ± 122 μm preoperatively to 314 ± 90 μm 3 years postoperatively (p < 0.001, generalized estimating equation). Additional non-surgical treatment was not required for 29 (67%) eyes. The average number of annual non-surgical treatments decreased from 5.04 times preoperatively to 0.34 times postoperatively. Seventeen (40%) eyes developed temporary ocular hypertension after surgery, which normalized after antihypertensive eye drop instillation. In conclusion, vitrectomy combined with intraoperative dexamethasone implantation provides satisfactory long-term clinical outcomes for non-tractional refractory DME while reducing the number of intraocular injections for DME.

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“…Pars plana vitrectomy (PPV) remains a viable option in the treatment regimen for DMO and plays a role, especially in the context of managing concomitant DMO and vitreomacular interface disturbance [198]. Even in the absence of the most serious complications of proliferative diabetic retinopathy (vitreous haemorrhage and retinal detachment), there is considerable evidence that vitrectomy reduces macular oedema in patients with DMO, especially in those with clinically evident signs of a taut, thickened posterior hyaloid [199][200][201][202][203][204][205][206][207]. Furthermore, vitrectomy has an acceptable risk profile compared with anti-VEGF therapy considering rates of major complications for each procedure [208].…”

Section: Surgerymentioning

confidence: 99%

Diabetic Macular Oedema Guidelines: An Australian Perspective

Yuen

Gilhotra

Dalton³

et al. 2023

Journal of Ophthalmology

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The number of people living with diabetes is expected to rise to 578 million by 2030 and to 700 million by 2045, exacting a severe socioeconomic burden on healthcare systems around the globe. This is also reflected in the increasing numbers of people with ocular complications of diabetes (namely, diabetic macular oedema (DMO) and diabetic retinopathy (DR)). In one study examining the global prevalence of DR, 35% of people with diabetes had some form of DR, 7% had PDR, 7% had DMO, and 10% were affected by these vision-threatening stages. In many regions of the world (Australia included), DR is one of the top three leading causes of vision loss amongst working age adults (20–74 years). In the management of DMO, the landmark ETDRS study demonstrated that moderate visual loss, defined as doubling of the visual angle, can be reduced by 50% or more by focal/grid laser photocoagulation. However, over the last 20 years, antivascular endothelial growth factor (VEGF) and corticosteroid therapies have emerged as alternative options for the management of DMO and provided patients with choices that have higher chances of improving vision than laser alone. In Australia, since the 2008 NHMRC guidelines, there have been significant developments in both the treatment options and treatment schedules for DMO. This working group was therefore assembled to review and address the current management options available in Australia.

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Macular ischemia and outcome of vitrectomy for diabetic macular edema

Abstract: Vitrectomy is an effective treatment modality for DME refractory to nonsurgical therapies, especially in cases without enlarged FAZ. Preoperative evaluation of the perfusion status of the macula seems helpful to selecting candidates for vitrectomy.

Cited by 12 publications

References 42 publications

The association between different hypoglycemic regimens and postoperative diabetic macular edema after vitrectomy in the Japanese patients with proliferative diabetic retinopathy

The association between different hypoglycemic regimens and postoperative diabetic macular edema after vitrectomy in the Japanese patients with proliferative diabetic retinopathy

Three-year outcomes of vitrectomy combined with intraoperative dexamethasone implantation for non-tractional refractory diabetic macular edema

Diabetic Macular Oedema Guidelines: An Australian Perspective

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