Surgical treatment for diabetic macular edema

Purpose. Improving the efficiency of surgical treatment of patients with diabetic macular edema and epiretinal membrane. Material and methods. Clinical studies were based on the analysis of morphological and functional parameters of the central retina. Patients with diffuse diabetic macular edema (DME) and epiretinal membrane (ERM) made up group A (main) of 96 people (96 eyes). Group B (control) included 22 patients (44 eyes) without ophthalmological diseases. Depending on the chosen method of surgical treatment, patients in group A were divided into three subgroups. Results. According to the data of optical coherence tomography, it was revealed that the average index of retinal thickness as a result of edema increased by 1.35 times (p=0.011) compared with group B. When conducting microperimetry in the macular zone in patients of group A, the total light sensitivity was reduced in 1.88 times compared with group B (p=0.028). Comparative analysis of long-term results of surgical treatment of patients with DMO and ERM showed that complex simultaneous vitrectomy and administration of an angiogenesis inhibitor is preferable compared to delayed administration of drugs, which is confirmed by a decrease in the total thickness of the retina in 78.3% of cases, preservation of the total photosensitivity of the central part of the retina on average, up to 15.3±3.24 dB, visual acuity - up to 0.51±0.22, no recurrence of edema in 63.4% of patients and the development of ERM - in 100% of cases. Conclusion. If the central thickness of the retina at the preoperative stage is less than 400 microns, it is possible to use a step-by-step method (vitrectomy + intravitreal administration of an angiogenesis inhibitor after 1 month). The use of the proposed one-step operation technique is preferable when the retina thickness is more than 400 microns. Vitrectomy with peeling of the internal limiting membrane in patients with cysts in the retinal edema zone with a diameter of more than 200 µm does not lead to a positive anatomical and functional result. Key words: diabetic macular edema, angiogenesis inhibitor, vitrectomy, microperimetry, epiretinal membrane.

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Sub-macular Injection of Ranibizumab as a New Surgical Treatment for Refractory Diabetic Macular Edema

Case Medical Research ◽

10.31525/ct1-nct03975088 ◽

2019 ◽

Author(s):

Keyword(s):

Surgical Treatment ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Refractory Diabetic Macular Edema

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Сomparative Analysis of the Long-Term Results of Diabetic Macular Edema and Epiretinal Membrane Surgical Treatment

Ophthalmology in Russia ◽

10.18008/1816-5095-2019-1s-33-39 ◽

2019 ◽

Vol 16 (1S) ◽

pp. 33-39

Author(s):

M. M. Bikbov ◽

R. M. Zainullin ◽

T. R. Gilmanshin ◽

T. A. Khalimov

Keyword(s):

Comparative Analysis ◽

Surgical Treatment ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Epiretinal Membrane ◽

Angiogenesis Inhibitor ◽

Central Zone ◽

Functional Results ◽

Long Term Results ◽

Quantitative Composition

The purpose of the study — to conduct a comparative analysis of structural and functional indicators of the central zone of the retina in patients with diabetic macular edema and epiretinal membrane in the remote period after surgical treatment. Patients and Methods. We examined 97 patients with diabetic macular edema in combination with the epiretinal membrane aged 53 to 68 years (mean age 61 ± 5.4 years). All patients underwent vitrectomy with an internal limiting membrane peeling (ILM). Patients were divided into 3 groups depending on the intravitreal use of an angiogenesis inhibitor. The analysis of the remote anatomical and functional results of patients of different groups during 1 year of observation was carried out. Results. In patients after treatment using the proposed technique, the central retinal thickness was reduced by 16.19 % (p = 0.031) compared with monotherapy and by 11.51 % (p = 0.039) compared with a phased treatment method. Visual acuity significantly increased in the treatment group by the single-step method by 1.53 times (p = 0.024) compared with the group where only vitrectomy was performed, and also 1.44 times (p = 0.029) compared with the delayed administration of angiogenesis inhibitor in avital eye. Patients in all groups have showed an improvement in central photosensitivity 1 month after surgery, followed by a slight decrease in performance. However, by 12 months, the level of central photosensitivity in group 2 was significantly higher than in other groups (p < 0.05). A comparative analysis of the spatial distribution of macular pigment has showed that, along with the development of the pathological process, macular pigments were dispersed in the retinal tissue. On the background of treatment, their concentration was normalized in the central zone of the retina, without increasing the quantitative composition. Conclusion Analysis of the morphofunctional parameters of the retina central section in patients with diabetic macular edema and epiretinal membrane in the dynamics of treatment with various techniques led to the creation of an algorithm for managing patients. It allows to achieve high clinical and functional results in an overwhelming percentage of cases and, thereby, significantly improve medical and social rehabilitation, and also the quality of life of this contingent.

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Three-year outcomes of vitrectomy combined with intraoperative dexamethasone implantation for non-tractional refractory diabetic macular edema

Scientific Reports ◽

10.1038/s41598-020-80350-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sungsoon Hwang ◽

Se Woong Kang ◽

Kyung Tae Kim ◽

Hoon Noh ◽

Sang Jin Kim

Keyword(s):

Surgical Treatment ◽

Macular Edema ◽

Clinical Outcomes ◽

Diabetic Macular Edema ◽

Estimating Equation ◽

Generalized Estimating Equation ◽

Refractory Diabetic Macular Edema ◽

Surgical Treatments ◽

Non Surgical Treatment

AbstractThis retrospective, consecutive interventional study investigated the long-term clinical outcomes of combined vitrectomy with intraoperative dexamethasone implants for non-tractional refractory diabetic macular edema (DME). The study included 43 eyes from 39 participants with DME that had continued for more than 6 months despite repeated non-surgical treatment. Postoperative changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated over 3 years. A Kaplan–Meier curve was obtained for any additional non-surgical treatment, and the average number of non-surgical treatments required for DME before and after surgery was compared. Other postsurgical complications were also investigated. The logMAR BCVA improved from 0.526 ± 0.417 (20/67) preoperatively to 0.294 ± 0.374 (20/39) 3 years postoperatively (p < 0.001, generalized estimating equation). The CMT improved from 478 ± 122 μm preoperatively to 314 ± 90 μm 3 years postoperatively (p < 0.001, generalized estimating equation). Additional non-surgical treatment was not required for 29 (67%) eyes. The average number of annual non-surgical treatments decreased from 5.04 times preoperatively to 0.34 times postoperatively. Seventeen (40%) eyes developed temporary ocular hypertension after surgery, which normalized after antihypertensive eye drop instillation. In conclusion, vitrectomy combined with intraoperative dexamethasone implantation provides satisfactory long-term clinical outcomes for non-tractional refractory DME while reducing the number of intraocular injections for DME.

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