Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid

Pendergast, Scott D.; Hassan, Tarek; Williams, George A.; Cox, Morton S.; Margherio, Raymond R.; Ferrone, Philip J.; Garretson, Bruce R.; Trese, Michael T.

doi:10.1016/s0002-9394(00)00472-4

Cited by 234 publications

(153 citation statements)

References 18 publications

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“…Because of its rarity and difficult diagnosis, most studies on this condition are limited to small series. Some authors [153,154,155,156] reported positive outcomes in up to 90% of eyes, with visual acuity improving to 5/10 or more in almost 30%. However, the benefits seem to be short-lived, as acuity can drop again in the medium-long term and the indications for surgery in diabetic macular edema have yet to be established more firmly.…”

Section: Macular Edemamentioning

confidence: 99%

Diabetic retinopathy

2002

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Abstract. Easy observation of the fundus oculi makes retinopathy the most frequently reported chronic complication of diabetes and, consequently, the one we know best in terms of epidemiology and natural history. Achieving near-normal levels of blood glucose and blood pressure provides empirical though powerful tools for clinicians to delay the onset and progression of diabetic retinopathy. Even when these measures have failed and retinopathy becomes sight-threatening, laser photocoagulation has proven remarkably effective. Nonetheless, retinopathy remains a leading cause of blindness and there is little evidence that diabetes-related visual loss is decreasing in industrialized countries. This may result from the mixed blessing of prolonged survival of patients who had become diabetic when metabolic control was pursued less fastidiously than today. Screening for sight-threatening retinopathy is the most cost-effective medical procedure known and should help optimise the use of diagnostic and therapeutic resources, but its widest deployment still meets with inertia and lack of interest within most health care systems. Improving clinical skills and technology, however, allow us to take a more optimistic look at the future, as pathogenesis-targeted forms of treatment are being developed and tested through appropriately powered clinical trials. [Diabetologia (2002[Diabetologia ( ) 45:1617[Diabetologia ( -1634

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Section: Macular Edemamentioning

confidence: 99%

Diabetic retinopathy

2002

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“…17 (11,23) 17 (13,22) 15 (8,22) 18 (12,22) 17 (11,25) 20 (7,30) Hemoglobin A1c Median (quartiles) * 6.9 (6.3, 8.1) 7.0 (6.5, 8.2) 7.4 (5.9, 7.8) 7.3 (6.4, 8.4) 6.7 (6.3, 7.4) 7.1 (6.2, 7.7) Prior Treatment for Diabetic Macular Edema (DME) in Study Eye-N(%) None…”

Section: Duration Of Diabetes Median (Quartiles)-yearsmentioning

confidence: 99%

A Phase II Randomized Clinical Trial of Intravitreal Bevacizumab for Diabetic Macular Edema

2007

Ophthalmology

372

115

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Objective-To provide data on the short-term effect of intravitreal bevacizumab for diabetic macular edema (DME). Design-Randomized phase 2 clinical trial.Participants-121 eyes of 121 subjects (109 eligible for analysis) with DME and Snellen acuity equivalent ranging from 20/32-20/320.Interventions-Random assignment to one of five groups: focal photocoagulation at baseline (N=19, Group A), intravitreal injection of 1.25mg bevacizumab at baseline and 6 weeks (N=22, Group B), intravitreal injection of 2.5mg bevacizumab at baseline and 6 weeks (N=24, Group C), intravitreal injection of 1.25mg bevacizumab at baseline and sham injection at 6 weeks (N=22, Group D), or intravitreal injection of 1.25mg bevacizumab at baseline and 6 weeks with photocoagulation at 3 weeks (N=22, Group E).Main Outcome Measures-Central subfield thickness (CST) on optical coherence tomography and best-corrected visual acuity (VA) were measured at baseline and after 3, 6, 9, 12, 18, and 24 weeks.Results-At baseline, median CST was 411 microns and median Snellen VA equivalent was 20/50. Compared with Group A, Groups B and C had a greater reduction in CST at 3 weeks and about one line better median visual acuity over 12 weeks. There were no meaningful differences between Groups B and C in CST reduction or VA improvement. A CST reduction >11% (the reliability limit) was present at 3 weeks in 36/84 (43%) bevacizumab-treated eyes and in 5/18 (28%) eyes treated with laser alone, and at 6 weeks in 31/84 (37%) and 9/18 (50%) eyes, respectively. Combining focal photocoagulation with bevacizumab resulted in no apparent short-term benefit or adverse outcomes. Endophthalmitis developed in one eye. The following events occurred during the first 24 weeks in subjects treated with bevacizumab without attributing cause to the drug: myocardial infarction (N=2), congestive heart failure (N=1), elevated blood pressure (N=3), and worsened renal function (N=3).Conclusion-These results demonstrate that intravitreal bevacizumab can reduce DME in some eyes, but the study was not designed to determine whether treatment is beneficial. A phase 3 trial would be needed for that purpose.

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“…[10][11][12] In several studies, vitrectomy was found beneficial for DME even when the latter is not combined with macular traction. [14][15][16][17][18] If additional data prove a cause-and-effect association between vitreopapillary traction and diffuse DME in some eyes, it is possible that in the aforementioned studies, some of these cases could have been associated with vitreopapillary traction, a phenomenon that does not seem rare. 2 Furthermore, vitrectomy might treat existing peripapillary detached retina and its sequelae.…”

Section: Discussionmentioning

confidence: 99%

“…In another study on diffuse DME associated with taut posterior hyaloid unresponsive to laser treatment, in which the premacular posterior hyaloid was attached, vitrectomy with removal of the posterior hyaloid was beneficial in some cases. 14 Kaiser et al 15 reported on nine patients who had thickened, taut posterior hyaloid, with no posterior vitreous detachment. Eight of the nine eyes had posterior hyaloid traction of the macula associated with a shallow macular traction detachment.…”

Section: Introductionmentioning

confidence: 99%

Diabetic vitreopapillary traction and macular oedema

Karataş

Ramírez

Ophir

2004

Eye

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Purpose To describe an association between optic disc traction and diabetic macular oedema (DME) unresponsive to laser treatment. Methods A retrospective review of all patients with DME who attended our clinic between September 2001 and November 2003 was undertaken. The patients had undergone ophthalmic history and examination, fluorescein angiography, and optical coherence tomography (OCT) of the macular area and optic nerve head (ONH). A total of 10 nonvitrectomized eyes that were found to have an elevation of the ONH secondary to vitreopapillary traction were included in the analysis. Eyes with additional traction at the posterior pole were excluded. Results Out of the 10 eyes (seven patients, aged 47-79 years) with vitreo-papillary traction, nine had previously undergone argon laser photocoagulation(s) for DME. In seven eyes (seven patients), OCT verified the vitreopapillary traction as the sole traction, whereas in the fellow eyes of three patients vitreomacular traction was evident as well. In the seven eyes with only vitreopapillary traction, OCT demonstrated parapapillary serous retinal detachment in two eyes and a diffuse DME in all eyes (mean foveal thickness, 3967144 lm). Maximal thickness of the papillo-macular bundle site was adjoining the elevated ONH in three eyes, and was maximal at the central macula in the other four eyes. Ultrasonography (n ¼ 5) revealed an incomplete detachment of the posterior hyaloid in each, adherent only at the ONH. Conclusions Diffuse DME unresponsive to laser treatment may be associated with vitreopapillary traction. Further studies should indicate whether these two phenomena could suggest a cause and effect in such eyes.

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Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid

Cited by 234 publications

References 18 publications

Diabetic retinopathy

Diabetic retinopathy

A Phase II Randomized Clinical Trial of Intravitreal Bevacizumab for Diabetic Macular Edema

Diabetic vitreopapillary traction and macular oedema

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