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

Yanyalı, Ateş; Bozkurt, Kansu Tahir; Maçin, Aydın; Horozoğlu, Fatih; Nohutçu, Ahmet F.

doi:10.1159/000327597

Cited by 35 publications

(25 citation statements)

References 79 publications

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“…PPV has been shown to be useful in the treatment of DME in some patients. [2][3][4][5][6][30][31][32][33][34] The mechanism for the effect of vitrectomy on DME may involve both release of vitreomacular traction and increased diffusion of advanced glycation end products, VEGF, and other cytokines away from the retina. 1,31-33 These findings suggest that sustained drug delivery with an implant could be particularly useful in vitrectomized eyes, thus enhancing and boosting the primary effect of vitrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…1 PPV effectively treats DME associated with vitreomacular traction, but several authors have also documented excellent results following surgery for fovea involving diffuse DME without apparent vitreomacular traction. [2][3][4][5][6] However, for many patients, the chronic and recurrent nature of retinal diseases requires continued drug therapy after surgical procedure. [7][8][9] Experience with VEGF 10 and a number of drugs, including triamcinolone acetonide, 11,12 amphotericin B, 13 and 5-fluorouracil, 14 suggests that some drugs are cleared more rapidly in vitrectomized eyes.…”

Section: Introductionmentioning

confidence: 99%

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Dexamethasone Intravitreal Implant in Vitrectomized Versus Nonvitrectomized Eyes for Treatment of Patients with Persistent Diabetic Macular Edema

Dutra-Medeiros

Alkabes

Navarro

et al. 2014

Journal of Ocular Pharmacology and Therapeutics

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dexamethasone Intravitreal Implant in Vitrectomized Versus Nonvitrectomized Eyes for Treatment of Patients with Persistent Diabetic Macular Edema

Dutra-Medeiros

Alkabes

Navarro

et al. 2014

Journal of Ocular Pharmacology and Therapeutics

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“…In a previous report 12 with 48 eyes of 37 patients post-vitrectomy for DME, postoperative visual acuity in the IS/OS intact group was found to be significantly better than that in IS/OS disrupted group. However, in that study different from ours, other variables that might affect the integrity of photoreceptor layer, including preoperative IS/OS status, macula thickness measurements such as central subfoveal thickness were not evaluated.…”

Section: Discussionmentioning

confidence: 74%

“…There have been a few reports demonstrating the association between the preservation of the IS/OS junction and better final visual acuity following DME resolution. 11,12 However, in these studies, the integrity of the outer retinal layer damage was not quantified and the study population was limited specifically to patients who had either intravitreal (IV) triamcinolone injections or pars plana vitrectomy. 11,12 …”

Section: Introductionmentioning

confidence: 99%

Integrity of Outer Retinal Layers After Resolution of Central Involved Diabetic Macular Edema

Müftüoğlu

Mendoza

Gaber

et al. 2017

Retina

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Purpose To evaluate the integrity of outer retina layers after resolution of central involved diabetic macular edema (DME) and to demonstrate the effect of various baseline factors for the final vision and final external limiting membrane (ELM) integrity. Methods Fifty-nine eyes of 48 patients with resolved DME were included. Several optical coherence tomography parameters including central subfield thickness (CST), maximum foveal thickness, foveal center point thickness and the extent of the ellipsoidal (ISe) layer and ELM damage were assessed at the time of DME and after resolution of DME. Eyes having laser scars near the fovea were excluded. Final visual acuity was classified as good (Snellen≥20/40, logMAR ≤0.3) or impaired (Snellen <20/40, logMAR>0.3) for the logistic regression analysis. Zero Inflated Poison Regression model was used to find the best predictors for post treatment ELM damage. Results External limiting membrane and ISe layers were disrupted in 16 (27.2%) eyes and 21 (35.5%) eyes at the final visit, respectively. Baseline ELM damage (p=0.001), baseline impaired vision (p= 0.013) and the most recent HbA1c level (p=0.018) were the best set of parameters for having impaired final visual acuity. Baseline vision, severity of diabetic retinopathy, absence of intravitreal injection, CST and history of extra-foveal macular laser (not within 1 mm of fovea) (p<0.001, for all parameters) were independent predictors for the final ELM damage. Conclusion Outer retinal layers may be damaged even after complete resolution of DME, where ISe damage appeared to be more common than ELM damage. Poorly controlled diabetic patients with damaged ELM and worse vision at the time of DME were more likely to have ELM damage and subsequent impaired vision after complete resolution of DME.

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“…This was an adaptation of a published method for quantitative assessment of the OCT photoreceptor layer. 8 Statistical analysis was performed with XLSTAT version 2014.6.02 (Addinsoft, New York, NY, USA) software. A Kaplan-Meier graph comparing survival time of subfoveolar blebs for the RHD and TRT groups was plotted.…”

Section: Methodsmentioning

confidence: 99%

Persistent subfoveolar fluid following retinal detachment surgery: an SD-OCT guided study on the incidence, aetiological associations, and natural history

Tee

Veckeneer

Laidlaw

2016

Eye

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Purpose To investigate the incidence and natural history of persistent subfoveolar fluid (PSF) following surgery for macular off rhegmatogenous retinal detachment and the effect of PSF on photoreceptor structure and final visual acuity. Methods Retrospective study of 61 cases with post-operative optical coherence tomography (OCT) performed within 12 weeks of surgery. Based on aetiology, cases were categorized into tractional retinal tears (TRT) group or atrophic round holes and dialyses (RHD) group to investigate the incidence and duration of PSF. A Kaplan-Meier graph was plotted to compare survival time of subfoveolar fluid for both groups. Following secondary reclassification of cases into those with and without PSF, the effect of PSF on final visual acuity and photoreceptor structure was investigated with Mann-Whitney U-test used for comparison. Spearman's correlation testing was used to probe associations between time to recorded resolution of PSF with final visual acuity and photoreceptor structure. Results Incidence of PSF was greater in the RHD group and persisted for longer compared with TRT group. No detectable adverse effect of PSF on final visual acuity was seen however an individual case of severe photoreceptor atrophy was observed. No significant correlation was found between the time to recorded resolution of PSF and the final visual acuity or to photoreceptor grading scores. Conclusions A difference in incidence of PSF was detected between the aetiological groups. PSF was ubiquitous and slow to resolve in the RHD group. Most cases of PSF resolve without adverse sequelae; however, progressive photoreceptor atrophy and sub-optimal visual outcome may result in a minority.

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

Cited by 35 publications

References 79 publications

Dexamethasone Intravitreal Implant in Vitrectomized Versus Nonvitrectomized Eyes for Treatment of Patients with Persistent Diabetic Macular Edema

Dexamethasone Intravitreal Implant in Vitrectomized Versus Nonvitrectomized Eyes for Treatment of Patients with Persistent Diabetic Macular Edema

Integrity of Outer Retinal Layers After Resolution of Central Involved Diabetic Macular Edema

Persistent subfoveolar fluid following retinal detachment surgery: an SD-OCT guided study on the incidence, aetiological associations, and natural history

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