Pars plana vitrectomy in diabetic macular edema.
ABSTRACT To ascertain the association between the improvement of diabetic macular edema and increased visual acuity after pars plana vitrectomy.
From January 1994 to December 1996 we prospectively studied 18 patients (18 eyes, 7 women and 11 men, mean age 52 years, range 37-68) with type II diabetes and clinically significant macular edema. One group was composed of 9 patients presenting diffuse macular edema (DME); a second group with 9 patients presented cystoid macular edema (CME). All patients underwent pars plana vitrectomy.
Preoperative Snellen visual acuity was 20/143 in DME and 20/441 in CME. In both groups vision increased to 20/136 and 20/205, respectively, postoperatively. For the DME this difference was statistically significant (p<0.05) at 1 month after the surgery, but vision decreased again after 10 months reaching preoperative values.
Our results suggest that pars plana vitrectomy for diabetic macular edema may increase visual acuity in diffuse macular edema, although this increase is only short lived.
Article: Die Chirurgie des Makulaödems[Show abstract] [Hide abstract]
ABSTRACT: Das Makuladem wurde bereits Ende des 19. Jahrhunderts als Krankheitsbild beschrieben. Urschlich kommen berwiegend vaskulre, entzndliche, degenerative und kongenitale Erkrankungen oder Traumata in Frage. Mit zunehmender Kenntnis ber die Pathogenese des Makuladems haben sich auch die Therapieanstze im Laufe der Zeit gewandelt. Sie umfassen neben der Laserbehandlung oder der medikamentsen Therapie auch die chirurgische Intervention. Die Pars-plana-Vitrektomie (evtl. mit ILM-Peeling) scheint vor allem bei bestimmten Formen des Makuladems, die mit Pathologien des Glaskrpers bzw. der vitreoretinalen Grenzflche einhergehen, erfolgversprechend. Zur Behandlung therapieresistenter Formen des Makuladems gewinnt auch die intravitreale Medikamentenapplikation, z.B. von Triamcinolon, an Bedeutung.At the end of the nineteenth century, macular edema had already been recognized as a pathological condition. The main causes for macular edema are vascular, inflammatory, degenerative, and congenital diseases or trauma. The therapeutic approaches have changed along with the increasing knowledge on the underlying causes of action during the last few years and include laser treatment as well as surgical interventions. Pars plana vitrectomy (including ILM peeling) seems beneficial in cases of macular edema that are associated with alterations of the vitreous or the vitreoretinal interface. For the treatment of chronic macular edema, intravitreal application of agents such as triamcinolone has become an option.Der Ophthalmologe 05/2004; 101(6):618-625. DOI:10.1007/s00347-004-1027-z · 0.72 Impact Factor
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ABSTRACT: (1) To evaluate whether vitrectomy is preferable to further macular laser in improving visual acuity and resolving retinal thickening in patients with diabetic macular oedema (DMO) despite previous laser and no macular traction. (2) To determine the feasibility of further trials in this population in terms of magnitude of comparative clinical effect, rate of recruitment, and loss to follow up. A randomised controlled feasibility study. Patients with DMO and a visual acuity of 0.3 logMAR (6/12) or worse after one or more macular laser treatments were randomised on a 1:1 basis to either pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or further macular laser. Patients with a posterior vitreous detachment, biomicroscopic evidence of retinal traction, or a taut thickened posterior hyaloid (TTPH) were excluded. Primary outcome measures were (1) best corrected logMAR visual acuity, (2) mean central macular thickness on optical coherence tomography, and (3) rate of recruitment and loss to follow up. Analysis was on an intention to treat basis. 19 patients were randomised to PPV and 21 to further macular laser. The mean baseline logMAR visual acuity was 0.65 (SD 0.28) for the group randomised to PPV and 0.60 (0.23) for the group randomised to laser. The mean change in best corrected visual acuity of the vitrectomy group was deterioration by 0.05 logMAR, while in the control group the mean change was an improvement of 0.03 logMAR. The median (interquartile range) baseline central macular thickness was 403 (337, 492) for the group randomised to PPV and 387 (298, 491) for the controls randomised to laser. The median change in central macular thickness from baseline to review in the vitrectomy group was a thinning by 73 mum (20%) and by 29 mum (10.7%) in the control laser group. This single centre was able to recruit 40 patients in 18 months with follow up of 82% at 1 year. A randomised controlled trial was found to be potentially feasible in this population, the rate of recruitment was however slow and one in five patients were lost to follow up because of death and ill health. These data provide little evidence in terms of visual acuity and macular thickness of any benefit of vitrectomy over further macular laser in patients with an attached hyaloid, DMO despite previous laser, and no clinically evident macular traction or TTPH.British Journal of Ophthalmology 02/2005; 89(1):81-6. DOI:10.1136/bjo.2004.044966 · 2.81 Impact Factor
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ABSTRACT: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyaloid and have been refractory to standard laser treatment. Review of 26 eyes of 20 patients consecutively were treated with PPV with ILM peel for refractory diabetic macular edema. Eyes were included if they had been unresponsive to conventional treatment defined as at least two focal laser applications by a retina specialist. Paired t-testing was performed to determine if a change in both optical coherence tomography (OCT)-measured retinal thickness and logarithm of the minimum angle of resolution (logMAR) visual acuity occurred prior to and following PPV with epiretinal membrane vitrectomy. In addition, we performed multivariate regression analysis to determine if any clinical variables predicted a change in visual acuity. The mean age in the sample was 65 years (range 29-81 years). The mean follow-up time was 242 days (range 35-939). Sixteen of the 26 eyes were phakic and the remaining ten were pseudophakic. There was a statistically significant improvement of mean visual acuity from a preoperative logMAR vision of 1.0 to a best postoperative vision of 0.75 (p=0.016, paired t-test). Thirteen (50%) of the 26 eyes gained at least two lines of best-corrected Snellen acuity, three (11.5%) had a decline of at least two lines, and ten (38.5%) showed stable visual acuity. Regression analysis demonstrated that baseline worse visual acuity was the only clinical variable that was associated with improvement in visual acuity (beta=0.602, p=0.016; R (2)=28.7). Fourteen eyes had preoperative and postoperative OCT. Thirteen eyes (93%) had a significant decrease in foveal thickness; with an average preoperative thickness of 575 mum compared to a postoperative average of 311 mum (t=3.65, p=0.002). No surgical complications were observed during the follow-up period. Surgery for refractory diabetic edema without a taut hyaloid is associated with a significant improvement in visual acuity and diminution of retinal thickness as measured by OCT. Further investigations are warranted to define the role of surgery in the management of persistent diabetic macular edema.Albrecht von Graæes Archiv für Ophthalmologie 02/2005; 243(1):20-5. DOI:10.1007/s00417-004-0958-z · 2.33 Impact Factor