Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema

Recchia, Franco M.; Ruby, Alan; Recchia, Cynthia A. Carvalho

doi:10.1016/j.ajo.2004.09.076

Cited by 100 publications

(76 citation statements)

References 22 publications

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“…9 Removal of the ILM may prevent later ERM formation by removing a scaffold for proliferating astrocytes and myofibroblasts. 12,22 Furthermore, removal of the ILM guarantees complete separation of the posterior hyaloid from the macular surface. One study has shown that even after triamcinolone-assisted PPV, residual posterior hyaloid can still be found on the ILM by transmission electron microscopy.…”

Section: Discussionmentioning

confidence: 99%

“…A sample size of 11 in each group would be required to achieve an 80% testing power based on the results from our retrospective clinical and OCT study after diabetic vitrectomy for FVP (unpublished data), and the results from the earlier studies on diabetic macular oedema after ILM peeling. [11][12] The sample size in this study was decided by doubling the calculated number to assure a reliable result. Group 1 cases had surgery without concomitant ILM peeling.…”

Section: Methodsmentioning

confidence: 99%

“…4 This basement membrane scaffolding may play a role in the development of persistent macular oedema and in the proliferation, or reproliferation of ERM. 5 Earlier studies have suggested ILM peeling as an adjunct to macular surgery may improve surgical outcomes in certain macular diseases, such as macular holes, [6][7][8] epiretinal membranes, 9,10 and diabetic macular oedema; [11][12][13] however, the effect of ILM peeling in the prevention of postoperative ERM remains unknown in diabetic active FVP, which is characterized by a strong proproliferative biological environment. 14,15 To answer this question, we conducted a prospective, comparative case series study to evaluate the visual and functional outcomes of vitrectomy, with or without ILM removal, in eyes with progressive FVP.…”

Section: Introductionmentioning

confidence: 99%

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Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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Objective To evaluate the anatomical and functional results of internal limiting membrane (ILM) peeling during pars plana vitrectomy for fibrovascular proliferation (FVP) in diabetic retinopathy. Methods The study was a prospective comparative case series in design. Patients undergoing pars plana vitrectomy for mild to moderate diabetic FVP were divided into either Group 1: vitrectomy only, or Group 2: further ILM peeling in the macular area. Best-corrected visual acuity, fundus examination, and optical coherence tomography (OCT) were conducted at 3 and 6 months postoperatively. Results There were 26 eyes of 25 patients in Group 1 (non-ILM peeling) and 23 eyes of 22 patients in Group 2 (ILM peeling). At 6 months postoperatively, OCT-identifiable epiretinal membrane (ERM) was found in 10 of 26 eyes (38.5%) in Group 1and 0 of 23 eyes in Group 2 (P ¼ 0.001) and six eyes (23.1%) in Group 1 developed biomicroscopic ERM, whereas no patients in Group 2 had ERM (P ¼ 0.02) at 6 months. OCT identifiable ERM correlated significantly with central macular thickness (r ¼ À0.58, Po0.001), the presence of intraretinal cystic space (r ¼ 0.60, Po0.001), and fovea depression reappearance (r ¼ 0.36, P ¼ 0.008). Factors associated with poor visual outcome were macular detachment (Po0.001) and non-ILM peeling (P ¼ 0.004). Conclusions This pilot study suggests that ILM peeling during vitrectomy for diabetic fibrovascular proliferative membranes may minimize postoperative ERM formation and improve visual prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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“…Successful PPV surgery has enabled ophthalmologists to restore vision in a number of patients that would have previously been regarded as incurable. [1][2][3] Clinically, a number of artificial vitreal materials are available, which include silicone oil, heavy silicone oil, and polymeric gels. However, these materials may lead to undesirable side effects and even severe complications.…”

Section: Introductionmentioning

confidence: 99%

A new strategy to replace the natural vitreous by a novel capsular artificial vitreous body with pressure-control valve

Gao

et al. 2007

Eye

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Purpose The current vitreous substitutes such as silicone oil, heavy silicone oil, and polymeric gels that are directly injected into vitreous cavity frequently cause severe intraocular complications. There is a very urgent need to find a more suitable artificial vitreous substitute for pars plana vitrectomy (PPV) surgery. Methods We have devised a novel capsular artificial vitreous using tailor-made silicone rubber elastomer. The novel device was implanted into the vitreous cavity of rabbit after PPV and the eye was examined by ophthalmoscopy, fundus photography, and tonometry during an 8-week treatment period. B-scan ultrasonography, electroretinogram (ERG), and histological studies by light microscopy were also performed at the end of 8 weeks.Results The novel artificial vitreous body consists of a thin vitreous-like capsule with a silicone tube-valve system. The capsule can be folded and implanted into vitreous cavity through 1.5 mm incision on sclera. Physiological balanced solution (PBS) was then injected into the capsule and inflated to support retina and control intraocular pressure (IOP) through the tube-valve system subsequently fixed under the conjunctiva. Experiments using rabbits showed that the novel vitreous body could effectively support the retina and apparently induced no significant pathological changes in the eye over 8 weeks. Conclusion This approach may provide a new research strategy in the vitreous replacement technology. The novel artificial vitreous body device can effectively support retina, control IOP, and has good biocompatibility. It may be a good alternative to injecting artificial vitreous although its tamponade properties and usefulness still have to be proven in complex vitreoretinal diseases.

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“…100/178 eyes (56.2%) demonstrated an acuity improvement of two or more lines at final follow-up. 24,29,30,32,39,[47][48][49] The proportion of eyes in these studies that improved by more than two lines ranged from 50 to 78%.…”

Section: Introductionmentioning

confidence: 99%

Vitrectomy for diabetic macular oedema

Laidlaw

2008

Eye

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Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema

Cited by 100 publications

References 22 publications

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

A new strategy to replace the natural vitreous by a novel capsular artificial vitreous body with pressure-control valve

Vitrectomy for diabetic macular oedema

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