Surgical outcomes of vitrectomy for intractable diabetic macular edema
- PDF / 395,895 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 56 Downloads / 213 Views
RETINAL DISORDERS
Surgical outcomes of vitrectomy for intractable diabetic macular edema Ryo Mukai 1
&
Hidetaka Matsumoto 1 & Hideo Akiyama 1
Received: 9 June 2020 / Revised: 6 August 2020 / Accepted: 16 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate clinical outcomes of vitrectomy for intractable diabetic macular edema (DME) in which anti-vascular endothelial growth factor (anti-VEGF) agents or periocular steroid were not effective. Methods This retrospective study examined 27 eyes of 25 cases. The main measurements included changes in visual acuity (VA) and retinal morphology. Vitrectomies were performed using the Constellation System 25G. Results Prior to undergoing vitrectomy, patients were treated with anti-VEGF agents or periocular injection of triamcinolone acetonide. The average number of anti-VEGF agent injections was 3.1 ± 2.8. Triamcinolone was used in 15 eyes. There was no significant change in the mean logMAR best-corrected visual acuity (BCVA) between baseline and posttreatment, with values of 0.49 ± 0.29 and 0.55 ± 0.33, respectively (P = 0.31). Compared with preoperative BCVA, postoperative BCVA improved by more than two lines in 4 eyes (14%), remained the same in 17 eyes (63%), and decreased in 6 eyes (23%). Morphologically, retinal thickness improved by more than 50 μm in 16 eyes (59%), remained unchanged in 7 eyes (26%), and increased in 5 eyes (18%). Retinal edema resolved in all of the cases in which macular epiretinal membrane (ERM) or vitreomacular traction (VMT) was detected by optical coherence tomography during pretreatment. Conclusions Vitrectomy can potentially stabilize the retinal morphology in intractable DME and is likely more effective in DME cases accompanied by ERM or VMT. Keywords DME . Vitrectomy . Anti-VEGF . Triamcinolone
Introduction Diabetes is a major disease worldwide, with the International Diabetes Federation reporting that 463 million people suffer from diabetes globally [1]. In Japan, the prevalence of diabetic retinopathy has been estimated to be 10% in all patients with diabetes, with hemoglobin A1c (HbA1c) levels over 6.5% [2]. Diabetic macular edema (DME) is one of the major complications seen in diabetic retinopathy. As DME is a vision-threatening condition, various treatments have been attempted in patients with DME. Recently, anti-vascular endothelial growth factor (anti-VEGF) has become the major treatment for these patients, based on the results of the RISE and RIDE [3], VIVID [4], DRCR-net [5], and
* Ryo Mukai [email protected] 1
Department of Ophthalmology, Gunma University Graduate School of Medicine, 3-35-15 Showa-cho, Maebashi, Gunma 371-8511, Japan
Protocol-T studies [6]. Vitrectomies have been performed as a treatment for naïve patients with DME since 1992 [7], because initially the patients were reported to have a thickened and taut premacular posterior hyaloid membrane [7], which was thought to contribute to the development of DME. Subsequently, vitrectomy was used to treat DME with
Data Loading...
