Structural and functional features of the central retina and improvement of surgical treatment of patients with diabetic macular edema and epiretinal membrane

2021 ◽  
pp. 27-32
Author(s):  
R.M. Zainullin ◽  
Keyword(s):  
Surgical Treatment ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Epiretinal Membrane ◽  
Angiogenesis Inhibitor ◽  
Long Term Results ◽  
Central Retina ◽  
Group A ◽  
Functional Features ◽  
Group B

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.

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

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. 

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.

scholarly journals Surgical treatment of pulmonary sequestration in adults and children: long-term results

2020 ◽  
Vol 31 (1) ◽  
pp. 71-77
Author(s):  
Beatrice Trabalza Marinucci ◽  
Giulio Maurizi ◽  
Camilla Vanni ◽  
Giuseppe Cardillo ◽  
Camilla Poggi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Respiratory Symptoms ◽  
Pulmonary Sequestration ◽  
Adult Patients ◽  
Long Term Results ◽  
Study Results ◽  
Group A ◽  
Group B ◽  
Histological Results

Abstract OBJECTIVES Few experiences comparing paediatric and adult patients treated for pulmonary sequestration (PS) have been reported. Surgical treatment is considered the best choice, but the time of surgery is still controversial. We present our experience in this setting, comparing characteristics, histological results and outcome of paediatric and adult patients undergoing PS resection. METHODS Between 1998 and 2017, a total of 74 patients underwent lobectomy or sublobar resection for PS. Sixty patients were children (group A: ≤16 years old) and 14 were adults (group B: &gt;16 years old). Preoperative diagnosis was radiological. PS was intralobar (42 cases) and extralobar (32 cases). The operation was a muscle-sparing lateral thoracotomy or video-assisted thoracoscopic surgery. Preoperative characteristics, histological results and short-/long-term results of the 2 groups were retrospectively analysed and compared. RESULTS Thirty-seven percent of the patients in group A presented with respiratory symptoms and 79% in group B (P = 0.44). Most symptomatic patients were treated with a lobectomy. In group A, 2 patients (3%) had a malignant transformation of the lesion. Patients with a prenatal diagnosis treated after the age of 1 year became more symptomatic than those operated on before the age of 1 year (57% vs 23%; P = 0.08). No differences were found in postoperative complications. Long-term stable remission of respiratory symptoms was obtained in 91% of patients in group A and 100% in group B. Adulthood (P = 0.03) and the association with congenital cystic adenomatoid malformation (P = 0.03) were negative prognostic factors for the development of respiratory symptoms. CONCLUSIONS Surgical treatment of PS is safe and feasible. Despite the small number of patients included, study results indicated that an early operation during childhood may prevent the subsequent development of respiratory symptoms. Surgical treatment is also recommended to prevent the rare transformation into malignancy.

Surgical Versus Non-Surgical Treatment of Calcaneal Fractures in Children: A Long-term Results Comparative Study

2000 ◽  
Vol 21 (10) ◽  
pp. 825-832 ◽  
Author(s):  
Francesco Ceccarelli ◽  
Cesare Faldini ◽  
Franco Piras ◽  
Sandro Giannini
Keyword(s):  
Surgical Treatment ◽  
Skeletal Maturity ◽  
Long Term Results ◽  
Calcaneal Fractures ◽  
Articular Fractures ◽  
Fractures In Children ◽  
Group A ◽  
Group B ◽  
Non Surgical Treatment

This study compared surgical and non-surgical treatment of 46 calcaneal fractures in children aged 3-17 years. Patients were divided into: Group A ranging 3-14 years and Group B 15-17 years, and classified according to surgical or non-surgical treatment. Mean follow-up was 22.8 years. Extra-articular fractures were treated non-surgically and all results were satisfactory. Results of articular fractures in Group A were satisfactory regardless of the type of treatment. Articular fractures surgically treated in group B were satisfactory, and those non-surgically treated were mainly poor. Extra-articular fractures can be treated non-surgically. Articular fractures in skeletally immature children can be treated non-surgically; conversely, those in children with skeletal maturity must be treated surgically.

The importance of maintenance chemotherapy in the first and second lines of treatment of metastatic colorectal cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15583-e15583
Author(s):  
Danila Gridnev ◽  
Anatoly Popov ◽  
Dina Islamova ◽  
Vladislav Makarov ◽  
Edouard Vozny ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Surgical Treatment ◽  
Metastatic Colorectal Cancer ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Long Term Results ◽  
Maintenance Chemotherapy ◽  
Group A ◽  
Group B ◽  
The Right

e15583 Background: The first and second lines of CT is decisive in the treatment of colorectal cancer. Choosing the right one allows you to increase PFS and improve long-term results. Surgical treatment and maintenance chemotherapy (MT) increase PFS and OS, as they can be prescribed at any stage of treatment. Methods: The analysis included 192 patients diagnosed with metastatic colorectal cancer (mCRC) who received treatment between 2014 and 2019. The average age of the patients was 62 years. At the beginning of treatment, the overall condition of all patients was ECOG1. Primary mCRC had 129 (67%) patients. In 63 (33%) patients, locally advanced disease was first diagnosed, which were included in the study after progression. PFS and OS for all patients were calculated from the start of the 1st line. Localization of the primary tumor in 42 (22%) patients was on the right side of the colon and on the left side in 149 (78%) and 1 patient did not show primary tumor. Among the patients with primary metastatic disease, 100 (52%) had isolated metastases, while the remaining 92 (48%) had 2 or more localizations. Different types of surgical treatment of metastases in the liver occurred in 41 (21%) patients. 119 patients never received MT (with any number of lines) and made a comparison group(A). 73 patients received MT in at least one of the CT lines (B). 12 patients received MT in the 1st and 2nd CT (C). These groups were homogeneous in terms of gender, age, ECOG, accessibility of surgical treatment of distant metastasis, mutational status of the tumor, and accessibility of biotherapy. Evaluation of the effect was performed using RECIST criteria, at intervals of 3 months or the appearance of clinical symptoms of progression. The treatment was carried out before the progression. At the time of analysis, 94 patients are alive and continue to receive treatment. Results: We compared in all three groups: In group A: OS - 12.9 months, PFS 1-line CT - 9.5 months, PFS 2-line CT - 4.5 months In group B: OS - 27.6 months, PFS 1-line CT - 13.6 months, PFS 2-line CT - 9.1 months In group C: OS - 38.3 months, PFS 1-line CT - 14.2 months, PFS 2-line CT - 9.1 months. “Five-year” survival (In those patients who were observed from the start of the study for all 5 years) in group A was 5,8 %, in group B 15 %, and in group C 16 %. Conclusions: Increase of PFS and OS in patients who received MT at least at one of the stages of treatment, and continues to increase in patients receiving MT in the first two lines CT. Thus, MT is a necessary component of the treatment of mCRC.

scholarly journals Outcomes in diabetic macular edema switched directly or after a dexamethasone implant to a fluocinolone acetonide intravitreal implant following anti-VEGF treatment

2019 ◽  
Vol 57 (4) ◽  
pp. 469-478 ◽  
Author(s):  
Matus Rehak ◽  
Catharina Busch ◽  
Jan-Darius Unterlauft ◽  
Claudia Jochmann ◽  
Peter Wiedemann
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Fluocinolone Acetonide ◽  
Anti Vegf ◽  
Intravitreal Implant ◽  
Group A ◽  
Stopping Treatment ◽  
Cataract Development ◽  
Group B ◽  
Fluocinolone Acetonide Intravitreal Implant

Abstract Aims Fluocinolone acetonide (FAc) is an intravitreal corticosteroid implant approved for the second-line treatment of diabetic macular edema (DME). This study compared outcomes of patients with DME switched directly to an FAc implant, versus indirectly via dexamethasone, after anti-VEGF therapy failure. Methods This is a retrospective, single-center chart review. Patients were assigned to Group A (switched to FAc after anti-VEGF) or Group B (switched to dexamethasone and then to FAc after > 4 months). Charts were reviewed for best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP) and cataract development. Results Forty-nine eyes were included. BCVA increased and CMT decreased with anti-VEGF (both groups), and dexamethasone (Group B only), but regressed after stopping treatment. With FAc, BCVA increased rapidly and significantly: increases were maintained up to 36 months (P < 0.001), except at 18 and 9 months in Groups A and B, respectively. Significant CMT reductions (P < 0.001) were evident after 3 months and maintained up to 36 months in both groups. IOP increase > 21 mmHg occurred in 14 patients (nine in Group A, five in Group B): all were sufficiently treated with IOP-lowering drops. Nineteen phakic eyes (73.1%) developed cataract: seven underwent phaco-emulsification (two in Group A, five in Group B). Conclusions Similar functional and anatomical improvements occurred in FAc-treated eyes, regardless of whether they first received dexamethasone or switched directly to FAc after anti-VEGF. Safety signals were consistent with corticosteroid class effects. Early switch to FAc could benefit patients who respond insufficiently to anti-VEGF.

scholarly journals Evaluation of Vitrectomy with Planned Foveal Detachment as Surgical Treatment for Refractory Diabetic Macular Edema with or without Vitreomacular Interface Abnormality

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ahmed M. Abdel Hadi
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Case Series ◽  
Intravitreal Triamcinolone ◽  
Foveal Detachment ◽  
Refractory Diabetic Macular Edema ◽  
Group A ◽  
Vitreomacular Interface ◽  
Group 2 ◽  
Group B

Purpose. To evaluate the therapeutic efficacy of subretinal BSS injections done during vitrectomy for refractory diabetic macular edema (DME) resistant to other modes of treatment including previous vitrectomy. Materials and Methods. A prospective, interventional noncomparative case series in which cases had refractory DME with a central macular thickness (CMT) ≥ 300 μm, despite previous anti-VEGF therapy (ranibizumab or bevacizumab with shifting to aflibercept). Some cases even received intravitreal triamcinolone acetonide injection, before attempting this solution. The study included group 1, surgically naïve eyes, and group 2, cases with persistent edema despite a previous vitrectomy (7 eyes (25%)). The cases were also divided into group a, eyes with normal vitreomacular interface, and group b, with abnormal vitreomacular attachment (VMA) (6 (21.4%)). The 1ry endpoint for this study was the change in CMT after 9–12 months from surgery. The 2ry endpoints were change in BCVA, recurrence of DME, and surgical complications. Results. The study included 28 eyes, 6 (21.4%) of which suffered from edema recurrence. The mean recorded CMT was 496 ± 88.7 μm and 274.1 ± 31.6 μm preoperatively and postoperatively, respectively. In all eyes, the preoperative mean BCVA in decimal form was 0.2 ± 0.11, which improved significantly to 0.45 ± 0.2. In the end, the CMT of groups 1 and 2 measured 239 μm and 170.8 μm, respectively (p=0.019). The preoperative BCVA in groups 1 and 2 was 0.16 ± 0.07 and 0.37 ± 0.14, respectively, which improved to a mean of 0.34 ± 0.09 and 0.7 ± 0.16 postoperatively, respectively (p=0.185). Conclusion. Vitrectomy with a planned foveal detachment technique was shown to be a promising solution for refractory DME cases with rapid edema resolution. CMT was shown to improve more in eyes where conventional vitrectomy was not attempted. Moreover, cases with VMA resistant to pharmacotherapy was shown to respond well to this technique. The study has been registered in Contact ClinicalTrials.gov PRS Identifier: NCT03345056.

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.

Randomized trial of medical compression stockings versus two-layer short-stretch bandaging in the management of venous leg ulcers

Phlebologie ◽  
2009 ◽  
Vol 38 (04) ◽  
pp. 157-163 ◽  
Author(s):  
A. Franek ◽  
L. Brzezinska-Wcislo ◽  
E. Blaszczak ◽  
A. Polak ◽  
J. Taradaj
Keyword(s):  
Drug Therapy ◽  
Randomized Clinical Trials ◽  
Therapy Group ◽  
Long Term Results ◽  
Leg Ulcers ◽  
Compression Stockings ◽  
Venous Leg Ulcers ◽  
Group A ◽  
Group B ◽  
Medical Compression Stockings

SummaryA prospective randomized clinical trial was undertaken to compare a medical compression stockings with two-layer short-stretch bandaging in the management of venous leg ulcers. Study endpoints were number of completely healed wounds and the clinical parameters predicting the outcome. Patients, methods: Eighty patients with venous leg ulcers were included in this study, and ultimately allocated into two comparative groups. Group A consisted of 40 patients (25 women, 15 men). They were treated with the compression stockings (25–32 mmHg) and drug therapy. Group B consisted of 40 patients (22 women, 18 men). They were treated with the short-stretch bandages (30–40 mmHg) and drug therapy, administered identically as in group A. Results: Within two months the 15/40 (37.50%) patients in group A and 5/40 (12.50%) in group B were healed completely (p = 0.01). For patients with isolated superficial reflux, the healing rates at two months were 45.45% (10/22 healed) in group A and 18.18% (4/22 healed) in group B (p = 0.01). For patients with superficial plus deep reflux, the healing rates were 27.77% (5/18 healed) in group A and 5.55% (1/18 healed) in group B (p = 0.002). Comparison of relative change of the total surface area (61.55% in group A vs. 23.66% in group B), length (41.67% in group A vs. 27.99% in group B), width (46.16% in group A vs. 29.33% in group B), and volume (82.03% in group A vs. 40.01% in group B) demonstrated difference (p = 0.002 in all comparisons) in favour of group A. Conclusion: The medical compression stockings are extremely useful therapy in enhancement of venous leg ulcer healing (both for patients with superficial and for patients who had superficial plus deep reflux). Bandages are less effective (especially for patients with superficial plus deep reflux, where the efficiency compared to the stockings of applied compression appeared dramatically low). These findings require confirmation in other randomized clinical trials with long term results.

Sign in / Sign up

Export Citation Format

Share Document