scholarly journals Multifocal Electroretinogram Changes after Vitrectomy in Patients with Diabetic Macular Edema

2021 ◽  
Author(s):  
Fathy Elsalhy ◽  
Hisham Fawzy Khalil ◽  
Mohamed Mohamed-Aly Ibrahim
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Multifocal Electroretinogram ◽  
Internal Limiting Membrane ◽  
Diabetic Patients ◽  
Macular Area ◽  
Ilm Peeling ◽  
Group A ◽  
Pars Plana ◽  
Group B

Abstract Purpose: was to assess the results of vitrectomy with and without internal limiting membrane (ILM) peeling on retinal function and anatomy in patients with diabetic macular edema (DME). Methods: Pars plana vitrectomy (PPV) was done in 40 eyes of 40 patients with DME (15 male, 25 female). Patients were enrolled randomly into two different groups. Group A- comprised (20) eyes who underwent vitrectomy without ILM peeling. Group B- comprised (20) eyes who underwent vitrectomy with ILM peeling. For each patient, visual acuity (VA) examination (in decimal charts), assessment of central macular thickness (CMT) with optical coherence tomography (OCT) and multifocal eletroretinogram (MF-ERG) were done before and 3 months post vitrectomy. Results: Postoperative mean VA increased significantly (from 0.17 to 0.27 in group A and from 0.21 to 0.38 in group B). Mean CMT decreased significantly after surgery (from 493 μm to 315 μm in group A and from 502 μm to 299 μm in group B). Mean P1 wave amplitude (nV/ deg2) in the macular area increased after surgery (from 32.15 to 41.10 in group A and from 35.5 to 40.8 in group B). Mean P1 wave latency (millisecond) in the macular area decreased after surgery (from 50.30 to 36.40 in group A and from 49.5 to 39.2 in group B).Conclusion: Vitrectomy with and without ILM peeling improve VA and macular edema in diabetic patients moreover an increase of amplitude and reduction of the latency of the macular mf-ERGs indicated an improvement of the macular visual function.

Efficacy of Subthreshold Photocoagulation for Persistent Diabetic Macular Edema After Internal Limiting Membrane Peeling: A Retrospective Comparative Study

2021 ◽  
Author(s):  
Hirotsugu Takashina ◽  
Akira Watanabe ◽  
Koji Komatsu ◽  
Tadashi Nakano
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Internal Limiting Membrane ◽  
Macular Thickness ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Group A ◽  
Group B ◽  
Subthreshold Photocoagulation ◽  
Persistent Diabetic Macular Edema

Abstract Background Subthreshold photocoagulation is one of the therapeutic options for treating diabetic macular edema, and have characteristic advantages, which are the lack of chorioretinal damage and the repeatability of the treatment. However, the effect of subthreshold photocoagulation is thought to be minimal among these options. In this study, we retrospectively examined the efficacy of repeated subthreshold photocoagulation for persistent diabetic macular edema after vitrectomy with peeling of the internal limiting membrane. Methods We enrolled ten consecutive eyes of eight patients who underwent monthly Endpoint Management™ (EpM) six times for diabetic macular edema that persisted for more than 3 months after vitrectomy with internal limiting membrane peeling for epiretinal membrane, and classified according to the interval between vitrectomy and initial EpM (Group A: within 6 months, Group B: beyond 6 months). Two type of retinal thickness (central macular thickness and macular thickness within 3mm diameter of the fovea) were measured monthly using optical coherence tomography. Results Mean intervals between vitrectomy and initial EpM were 4.0 ± 1.2 months (range 3–6 months) in Group A (six eyes of five patients) and 17.3 ± 7.5 months (range 10–27 months) in Group B (four eyes of four patients). No other treatments were performed between vitrectomy and initial EpM in Group A, while triamcinolone acetonide injection in the sub-Tenon’s capsule was performed in two eyes in Group B (one eye was injected thrice, the other eye received a single injection). Improvement rates of mean central macular thickness after 6 months were 18.2% in all eyes, 10.8% in Group A, and 28.7% in Group B, and improvement rates of mean macular thickness within 3mm diameter of the fovea after 6 months were 8.5% in all eyes, 4.1% in Group A, and 15.3% in Group B. Conclusions Monthly EpM treatment was efficacious against persistent diabetic macular edema after internal limiting membrane peeling. In particular, the efficacy was greater in eyes in which the initial EpM was performed more than 6 months after vitrectomy. Furthermore, residual efficacy of triamcinolone acetonide, which was injected at the end of vitrectomy, might have contributed to the results.

Evaluation of Macular Changes in Long Term Period Following Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema

2021 ◽  
Author(s):  
Betul Onal Gunay ◽  
Gurkan Erdogan
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Additional Treatment ◽  
Final Visit ◽  
Ilm Peeling ◽  
Pars Plana

Aim: To evaluate long term macular changes following pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for diabetic macular edema (DME) Methods: Forty eligible eyes of 37 patients were included in this retrospective study. Best corrected visual acuity (BCVA), central macular thickness (CMT) and 5-mm macular volume (5-MV) were examined preoperatively and at postoperative 1st, 2nd, 3rd, 6th, 12th, 24th months and final visits. Response to surgical treatment was considered as recurrence, reincrease and recovery of DME based on macular changes. Results: Mean follow-up time was 51.1±19.0 months following surgery. Recurrence (n=5) and reincrease (n=17) of DME was observed in 22 eyes (55%) and additional treatments were applied. Recovery of DME was observed in 18 eyes (45%). Preoperative and final visit mean BCVAs (logMAR) were 1.08±0.37 and 0.93±0.45, respectively (p=0.02). Preoperative and final visit mean CMTs were 514.74±155.65 µm and 281.87±112.58 µm, respectively (p<0.001). The 5-MV significantly decreased following surgery (8.18±1.57 mm3 to 6.52±1.39 mm3) (p<0.001). DME was present in 12 eyes (%30) at final visit. Conclusion: Although PPV with ILM peeling had an efficacy in DME management, this effect tends to decrease over time such that considerable amount of patients required additional treatment.

scholarly journals Pars Plana Vitrectomy with Internal Limiting Membrane Peeling and Intravitreal Bevacizumab Injection for Refractory Diffuse Diabetic Macular Edema

2020 ◽  
Author(s):  
Aliagha Alishiri ◽  
Hamidreza Torabi ◽  
Khosrow Jadidi ◽  
Seyed Aliasghar Mosavi
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Correlation Coefficient ◽  
Diabetic Macular Edema ◽  
Pars Plana Vitrectomy ◽  
Intravitreal Bevacizumab ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Diffuse Diabetic Macular Edema ◽  
Pars Plana

Abstract Purpose: Evaluating the impact of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intravitreal bevacizumab (IVB) injection to manage refractory diffuse diabetic macular edema (DME).Methods: In the current prospective interventional clinical study, eyes with refractory diffuse DME with no response to a minimum of three times IVB injections, and best corrected visual acuity (BCVA) of equal or more than 20/200 and equal or lower than 20/60 were subjected to PPV with ILM peeling and intravitreal avastin injection. Pre- and post-operative assessments were a comprehensive ophthalmologic evaluation, fluorescein angiography, and optical coherence tomography (OCT). BCVA, central macular thickness (CMT) and contrast sensitivity (CS) were major outcomes. Results: Fifteen eyes of 13 cases (mean age: 63±5.19 (range, 54-70) years) were subjected to operation and a follow-up of 3 months. Average BCVA at last test was 0.74 ± 0.19 LogMAR that showed no improvement compared with its value before intervention (0.84 ± 0.14 LogMAR) (P=0.073). Average CMT at last test was 328.26±129 µm that was significantly lower compared with its value before operation (450.8±114 µm) (P=0.002) and a significant improvement in CS was found (from 16.66 ± 8.99 mm to 18.13 ±1.22mm;p=0.003). CMT and BCVA (correlation coefficient =0.419,p=0.120), BCVA and CS (correlation coefficient =-0.336,p=0.221) , and CS and CMT (correlation coefficient =-0.07,p=0.979) were found with no significant correlation. Conclusion: PPV with ILM peeling and IVB regarding refractory diffuse DME reduced macular width along with CS improvement, but does not significantly improve visual acuity.

scholarly journals Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Nontractional Diabetic Macular Edema

2017 ◽  
Vol 11 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Jan Niklas Ulrich
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Central Macular Thickness ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Pars Plana

Background: Diabetes mellitus remains the leading cause of blindness among working age Americans with diabetic macular edema being the most common cause for moderate and severe vision loss. Objective: To investigate the anatomical and visual benefits of pars plana vitrectomy with inner limiting membrane peeling in patients with nontractional diabetic macular edema as well as correlation of integrity of outer retinal layers on spectral domain optical coherence tomography to visual outcomes. Methods: We retrospectively reviewed the charts of 42 diabetic patients that underwent vitrectomy with internal limiting membrane peeling for nontractional diabetic macula edema. The integrity of outer retinal layers was evaluated and preoperative central macular thickness and visual acuity were compared with data at 1 month, 3 months and 6 months postoperatively. The student t-test was used to compare the groups. Results: 31 eyes were included. While no differences were seen at 1 and 3 months, there was significant improvement of both central macular thickness and visual acuity at the 6 months follow up visit compared to preoperatively (357, 427 microns; p=0.03. 20/49, 20/82; p=0.03) . Patients with intact external limiting membrane and ellipsoid zone had better preoperative vision than patients with outer retinal layer irregularities (20/54, 20/100; p=0.03) and greater visual gains postoperatively (20/33, p<0.001 versus 20/81; p=non-significant). Conclusion: Pars plana vitrectomy with internal limiting membrane peeling can improve retinal anatomy and visual acuity in patients with nontractional diabetic macular edema. Spectral domain optical coherence tomography may help identify patients with potential for visual improvement.

scholarly journals Diabetic Macular Edema-Like Ocular Lesions in Male Spontaneously Diabetic Torii Fatty Rats

2018 ◽  
pp. 423-432 ◽  
Author(s):  
Y. MOTOHASHI ◽  
Y. KEMMOCHI ◽  
T. MAEKAWA ◽  
H. TADAKI ◽  
T. SASASE ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Outer Nuclear Layer ◽  
Internal Limiting Membrane ◽  
Vitreous Humor ◽  
Diabetic Patients ◽  
New Therapeutic Approaches ◽  
Number Of Patients ◽  
Ocular Lesions

Diabetic macular edema (DME) is a major factor contributing to visual disabilities in diabetic patients, and the number of patients is increasing. Animal models play a key role in the development of novel therapies. In this study, pathophysiological analyses of ocular lesions in Spontaneously Diabetic Torii (SDT) fatty rats were performed. First, vascular endothelial growth factor (VEGF) concentrations in vitreous humor, retinal vascular permeability and retinal thickness were measured in SDT fatty rats (Experiment 1). Furthermore, the pharmacological effects of two anti-diabetic drugs, phlorizin and pioglitazone, on retinal lesions were evaluated (Experiment 2). As results, the SDT fatty rats exhibited VEGF increase in vitreous humor at 8 and 16 weeks of age, and both retinal vascular hyperpermeability and retinal thickening at 16 weeks of age. In particular, the layers between the retinal internal limiting membrane and the outer nuclear layer were thickened. Phlorizin treatment from 4 to 16 weeks of age improved hyperglycemia and normalized retinal thickness; however, the effect of pioglitazone on retinal thickness was not strong despite the normalization of hyperglycemia. These data demonstrate that the male SDT fatty rat is a useful model for developing new therapeutic approaches in DME.

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