PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective...PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective, consecutive, interve ntional case series. METHODS: Diabetic patients with biomicroscopic, angiographi c, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for in clusion. Patients with biomicroscopic evidence of epiretinal membrane or taut po sterior hyaloid, previous vitreoretinal surgery, or active proliferative diabeti c retinopathy were excluded. The main outcome measures were macular thickness, a s measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS : PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six wo men; mean age=58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20%in eight of 11 eyes (mean preoperative thickness of 421 μm compare d with mean postoperative thickness of 188 μm; P=.007). Mean VA improved from 2 0/352 to 20/94 at 6 months (P=.002). By the most recent visit (range=6-20 month s postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in so me eyes with chronic diabetic macular edema unresponsive or unamenable to additi onal laser photocoagulation.展开更多
Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (BAE). Design Retrospective, non comp arative, interventional case series. Participants Consecut...Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (BAE). Design Retrospective, non comp arative, interventional case series. Participants Consecutive patients treated a t one institution for BAE. Interventions Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitre al injection of antibiotics (tap and inject). Methods Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical pre sentation, treatment modality, microbiologic data, and clinical course were anal yzed. Visual outcomes were compared between vitrectomy and tap-and-inject grou ps, culture-positive and culture-negative groups, and early and late times. Ma in outcome measures Snellen visual acuities (VAs) at 3 months and 12 months afte r treatment and at most recent follow-up. Results The incidence of no light per ception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates i ncluded streptococcal species (32%of positive cultures), Staphylococcus epiderm idis (26%), Enterococcus, and Serratia (12%each). Patients with a positive vit reous culture had significantly worse VA (median, hand movements HM at 3 and 1 2 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months an d LP at 12 months) and a significantly higher rate of NLP vision than patients t reated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P=0.09). Conclusions Bleb associated endophthalmitis causes significant visual morbidity. Patients with culture-neg ative BAE and patients treated with prompt PPV may achieve better visual outcome .展开更多
文摘PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective, consecutive, interve ntional case series. METHODS: Diabetic patients with biomicroscopic, angiographi c, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for in clusion. Patients with biomicroscopic evidence of epiretinal membrane or taut po sterior hyaloid, previous vitreoretinal surgery, or active proliferative diabeti c retinopathy were excluded. The main outcome measures were macular thickness, a s measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS : PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six wo men; mean age=58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20%in eight of 11 eyes (mean preoperative thickness of 421 μm compare d with mean postoperative thickness of 188 μm; P=.007). Mean VA improved from 2 0/352 to 20/94 at 6 months (P=.002). By the most recent visit (range=6-20 month s postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in so me eyes with chronic diabetic macular edema unresponsive or unamenable to additi onal laser photocoagulation.
文摘Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (BAE). Design Retrospective, non comp arative, interventional case series. Participants Consecutive patients treated a t one institution for BAE. Interventions Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitre al injection of antibiotics (tap and inject). Methods Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical pre sentation, treatment modality, microbiologic data, and clinical course were anal yzed. Visual outcomes were compared between vitrectomy and tap-and-inject grou ps, culture-positive and culture-negative groups, and early and late times. Ma in outcome measures Snellen visual acuities (VAs) at 3 months and 12 months afte r treatment and at most recent follow-up. Results The incidence of no light per ception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates i ncluded streptococcal species (32%of positive cultures), Staphylococcus epiderm idis (26%), Enterococcus, and Serratia (12%each). Patients with a positive vit reous culture had significantly worse VA (median, hand movements HM at 3 and 1 2 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months an d LP at 12 months) and a significantly higher rate of NLP vision than patients t reated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P=0.09). Conclusions Bleb associated endophthalmitis causes significant visual morbidity. Patients with culture-neg ative BAE and patients treated with prompt PPV may achieve better visual outcome .
