Factors Predicting Outcome of Vitrectomy for Diabetic Macular Oedema: Results of a Prospective Study

Overview

Journal Br J Ophthalmol

Specialty Ophthalmology

Date 2005 Dec 20

PMID 16361663

Citations 29

Authors

S P Shah

M Patel

D Thomas

S Aldington

D A H Laidlaw

Affiliations

Soon will be listed here.

Abstract

Aim: To determine preoperative demographic, clinical, and optical coherence tomography (OCT) factors which might predict the visual and anatomical outcome at 1 year in patients undergoing vitrectomy and inner limiting membrane peel for diabetic macular oedema (DMO).

Methods: A prospective, interventional case series of 33 patients who completed 1 year follow up. Measurements were taken preoperatively and at 1 year. Outcome measures were logMAR visual acuity (VA) and OCT macular thickness. A priori explanatory variables included baseline presence of clinical and/or OCT signs suggesting macular traction, grade of diabetic maculopathy, posterior vitreous detachment, fluorescein leakage and ischaemia on angiography, presence of subretinal fluid, and peroperative indocyanine green (ICG) use.

Results: 33 patients completed 1 year follow up. On average VA deteriorated by 0.035 logMAR (p = 0.40). Macular thickness significantly improved by a mean of 139 microm (95% CI; 211 to 67, p<0.001). Patients with evidence of clinical and/or OCT macular traction significantly improved logMAR acuity (logMAR improvement = 0.08) compared with patients without traction (logMAR deterioration 0.11, p = 0.01). Presence of subretinal fluid significantly predicted worse postoperative result (p = 0.01)

Conclusion: On average, patients showed a statistically significant improvement in central macular thickness following treatment but a marginal acuity worsening. Presence of subretinal fluid on OCT is hypothesised to be exudative rather than tractional in nature. The visual benefit of vitrectomy for DMO in this study was limited to patients who exhibit signs of macular traction either clinically and/or on OCT.

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References

Otani T, Kishi S . Tomographic assessment of vitreous surgery for diabetic macular edema. Am J Ophthalmol. 2000; 129(4):487-94. DOI: 10.1016/s0002-9394(99)00409-2. View

Jahn C, Topfner von Schutz K, Richter J, Boller J, Kron M . Improvement of visual acuity in eyes with diabetic macular edema after treatment with pars plana vitrectomy. Ophthalmologica. 2004; 218(6):378-84. DOI: 10.1159/000080940. View

Gandorfer A, Messmer E, Ulbig M, Kampik A . Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina. 2000; 20(2):126-33. View

Ikeda T, Sato K, Katano T, Hayashi Y . Improved visual acuity following pars plana vitrectomy for diabetic cystoid macular edema and detached posterior hyaloid. Retina. 2000; 20(2):220-2. DOI: 10.1097/00006982-200002000-00023. View

Giovannini A, Amato G, Mariotti C, Scassellati-Sforzolini B . Optical coherence tomography findings in diabetic macular edema before and after vitrectomy. Ophthalmic Surg Lasers. 2000; 31(3):187-91. View

Tachi N, Hashimoto Y, Ogino N . Cystotomy for diabetic cystoid macular edema. Doc Ophthalmol. 2000; 97(3-4):459-63. DOI: 10.1023/a:1002496316425. View

Ferrari T, Cardascia N, Durante G, Vetrugno M, Cardia L . Pars plana vitrectomy in diabetic macular edema. Doc Ophthalmol. 2000; 97(3-4):471-4. DOI: 10.1023/a:1002464307469. View

Pendergast S, Hassan T, Williams G, Cox M, Margherio R, Ferrone P . Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol. 2000; 130(2):178-86. DOI: 10.1016/s0002-9394(00)00472-4. View

Kadonosono K, Itoh N, Ohno S . Perifoveal microcirculation before and after vitrectomy for diabetic cystoid macular edema. Am J Ophthalmol. 2000; 130(6):740-4. DOI: 10.1016/s0002-9394(00)00575-4. View

10.

Haouchine B, Massin P, Gaudric A . Foveal pseudocyst as the first step in macular hole formation: a prospective study by optical coherence tomography. Ophthalmology. 2001; 108(1):15-22. DOI: 10.1016/s0161-6420(00)00519-4. View

11.

Kaiser P, Riemann C, SEARS J, Lewis H . Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction. Am J Ophthalmol. 2001; 131(1):44-9. DOI: 10.1016/s0002-9394(00)00872-2. View

12.

Otani T, Kishi S . Tomographic findings of foveal hard exudates in diabetic macular edema. Am J Ophthalmol. 2001; 131(1):50-4. DOI: 10.1016/s0002-9394(00)00661-9. View

13.

La Heij E, Hendrikse F, Kessels A, Derhaag P . Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefes Arch Clin Exp Ophthalmol. 2001; 239(4):264-70. DOI: 10.1007/s004170000251. View

14.

Massin P, Vicaut E, Haouchine B, Erginay A, Paques M, Gaudric A . Reproducibility of retinal mapping using optical coherence tomography. Arch Ophthalmol. 2001; 119(8):1135-42. DOI: 10.1001/archopht.119.8.1135. View

15.

Yamamoto T, Akabane N, Takeuchi S . Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol. 2001; 132(3):369-77. DOI: 10.1016/s0002-9394(01)01050-9. View

16.

Sato Y, Lee Z, Shimada H . Vitrectomy for diabetic cystoid macular edema. Jpn J Ophthalmol. 2002; 46(3):315-22. DOI: 10.1016/s0021-5155(02)00471-9. View

17.

Otani T, Kishi S . A controlled study of vitrectomy for diabetic macular edema. Am J Ophthalmol. 2002; 134(2):214-9. DOI: 10.1016/s0002-9394(02)01548-9. View

18.

Kalvodova B, Zahlava J . [Results of vitrectomy in cystoid diabetic macular edema detected by optical coherence tomography]. Cesk Slov Oftalmol. 2002; 58(4):224-32. View

19.

Amino K, Tanihara H . Vitrectomy combined with phacoemulsification and intraocular lens implantation for diabetic macular edema. Jpn J Ophthalmol. 2002; 46(4):455-9. DOI: 10.1016/s0021-5155(02)00526-9. View

20.

Yamamoto T, Hitani K, Tsukahara I, Yamamoto S, Kawasaki R, Yamashita H . Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema. Am J Ophthalmol. 2002; 135(1):14-9. DOI: 10.1016/s0002-9394(02)01819-6. View