The effectiveness of vitrectomy for diffuse diabetic macular edema may depend on its preoperative optical coherence tomography pattern

Ichiyama, Yusuke; Sawada, Osamu; Mori, Takamasa; Fujikawa, Masato; Kawamura, Hajime; Ohji, Masahito

doi:10.1007/s00417-015-3251-4

Cited by 26 publications

(21 citation statements)

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“…Kaya and Aksoy for their interest and questions regarding our report on the effectiveness of vitrectomy in diffuse diabetic macular edema [1].In our study, we found that vitrectomy was effective for the treatment of diffuse diabetic macular edema, particularly in eyes with subretinal fluid (SRF). As the commenters indicated, SRF may be associated with impairment of the outer blood retinal barrier or of pump function of retinal pigment epithelium (RPE).…”

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confidence: 73%

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The possible mechanisms of subretinal fluid resolution after vitrectomy

Ichiyama

Ohji

2016

Graefes Arch Clin Exp Ophthalmol

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We wish to thank Drs. Kaya and Aksoy for their interest and questions regarding our report on the effectiveness of vitrectomy in diffuse diabetic macular edema [1].In our study, we found that vitrectomy was effective for the treatment of diffuse diabetic macular edema, particularly in eyes with subretinal fluid (SRF). As the commenters indicated, SRF may be associated with impairment of the outer blood retinal barrier or of pump function of retinal pigment epithelium (RPE). However, it is still unknown why dysfunction of RPE had developed in these patients with diabetic mellitus, so we cannot provide a robust answer as to why vitrectomy was effective for the resolution of SRF. Several possible reasons for this could be suggested, as follows: First, vitrectomy might improve the oxygenation of ischemic RPE and might increase the ability to pump fluid. Previous studies have demonstrated the decreased ability of RPE to pump fluid in hypoxic settings [2,3]. In patients with diabetic mellitus, RPE might be occurring in a hypoxic setting, although choroidal blood flow is high. Second, induction of posterior vitreous detachment (PVD) might improve the function of the outer retinal barrier. Previous reports demonstrated that vitreomacular adhesion and associated traction was strongly associated with the progression of neovascular age-related macular degeneration [4], and vitrectomy could be a suitable treatment [5]. These results suggested that surgical induction of PVD could have positive influence on the function of the outer retinal barrier. Finally, vitrectomy might increase external stimuli to RPE, resulting in enhanced RPE function, as Drs. Kaya and Aksoy suggested. However, all possible reasons described above have insufficient evidence for their establishment. Further research is needed to reveal the pathogenesis of diabetic macular edema, including SRF and the mechanisms of SRF resolution after vitrectomy. We really hope that our report can be of assistance in this work.

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confidence: 73%

“…Kaya and Aksoy for their interest and questions regarding our report on the effectiveness of vitrectomy in diffuse diabetic macular edema [1].…”

Section: To the Editormentioning

confidence: 99%

The possible mechanisms of subretinal fluid resolution after vitrectomy

Ichiyama

Ohji

2016

Graefes Arch Clin Exp Ophthalmol

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“…In our study, normal fovea contour was found in only 1 case, ERM and SF were found in 2 cases each, and MC, LFD, and SFD were documented after surgery. Although some authors have reported that preoperative OCT findings such as external limiting membrane integrity or presence of subretinal fluids may be closely related to final visual outcome [37,38] , it is important to review and analyze postoperative macular status on OCT after PPV in diabetic macular edema.…”

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confidence: 99%

Structural Changes of the Macula on Optical Coherence Tomography after Vitrectomy for Proliferative Diabetic Retinopathy

Kim

Park

et al. 2017

Ophthalmologica

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Purpose: This study aimed to evaluate the relationship between macular structural changes and visual prognosis after pars plana vitrectomy (PPV) for proliferative diabetic retinopathy. Methods: The study included 60 eyes that had undergone PPV. Macular optical coherence tomography (OCT) findings were classified into 5 groups preoperatively and 10 groups postoperatively. Best-corrected visual acuity (BCVA) were analyzed according to pre- and postoperative OCT. Results: From the preoperative OCT, normal fovea with/without traction, normal fovea with preretinal hemorrhage, and tractional retinal detachment involving fovea showed an increase in BCVA after PPV (all p < 0.05). Normal fovea, epiretinal membrane and macular thickening were common after surgery. Normal fovea, epiretinal membrane and edema outside of the fovea showed good visual prognosis (BCVA >20/50). Subfoveal fibrosis, macular hole, loss of foveal depression, and serous foveal detachment showed poor visual prognosis (BCVA <20/100). Conclusion: Macular structural changes were various after PPV, and visual prognosis correlated with these changes.

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“…101,[209][210][211][212][213][214][215][216] VA improvements however have not been as consistent and as significant as the reduction in retinal thickness following the procedure. 192,203,[217][218][219][220][221][222][223][224][225][226][227][228][229][230][231][232][233][234] This discrepancy between anatomical and functional results of vitrectomy for DME may be due to the inherent postoperative ocular sequelae, such as cataract formation that can confound VA interpretations. Also, surgical intervention continues to be reserved for those cases that have had chronic and severe forms of DME when retinal damage is irreversible thereby biasing the results.…”

Section: Surgical Management Of Diabetic Retinopathy and Diabetic Macmentioning

confidence: 99%

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Mansour¹,

Browning²,

Wong³

et al. 2020

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165

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Purpose: To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. Methods: A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. Results: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and ...

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The effectiveness of vitrectomy for diffuse diabetic macular edema may depend on its preoperative optical coherence tomography pattern

Abstract: Vitrectomy can be a useful treatment option for DDME, particularly for eyes with SRF.

Cited by 26 publications

References 26 publications

The possible mechanisms of subretinal fluid resolution after vitrectomy

The possible mechanisms of subretinal fluid resolution after vitrectomy

Structural Changes of the Macula on Optical Coherence Tomography after Vitrectomy for Proliferative Diabetic Retinopathy

<p>The Evolving Treatment of Diabetic Retinopathy</p>

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