Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyalo...Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyaloid and have been refractory to standard laser treatment. Methods: Review of 26 eyes of 20 patients consecutively were treated with PPV with ILM peel for refractory diabetic macular edema. Eyes were included if they had been unresponsive to conventional treatment defined as at least two focal laser applications by a retina specialist. Paired t- testing was performed to determine if a change in both optical coherence tomography (OCT)-Measured retinal thickness and logarithm of the minimum angle of resolution (logMAR) visual acuity occurred prior to and following PPV with epiretinal membrane vitrectomy. In addition, we performed multivariate regression analysis to determine if any clinical variables predicted a change in visual acuity. Results: The mean age in the sample was 65 years (range 29- 81 years). The mean follow-up time was 242 days (range35- 939). Sixteen of the 26 eyes were phakic and the remaining ten were pseudophakic. There was a statistically significant improvement of mean visual acuity from a preoperative logMAR vision of 1.0 to a best postoperative vision of 0.75 (P=0.016, paired t-test). Thirteen (50% ) of the 26 eyes gained at least two lines of best-corrected Snellen acuity, three (11.5% ) had a decline of at least two lines, and ten (38.5% ) showed stable visual acuity. Regression analysis demonstrated that baseline worse visual acuity was the only clinical variable that was associated with improvement in visual acuity (beta=0.602, P=0.016; R2=28.7). Fourteen eyes had preoperative and postoperative OCT. Thirteen eyes (93% )-had a significant decrease in foveal thickness; with an average preoperative thickness of 575 μ m compared to a postoperative average of 311 μ m (t=3.65, P=0.002). No surgical complications were observed during the follow-up period. Conclusions: Surgery for refractory diabetic edema without a taut hyaloid is associated with a significant improvement in visual acuity and diminution of retinal thickness as measured by OCT. Further investigations are warranted to define the role of surgery in the management of persistent diabeticmacular edema.展开更多
Objectives: To determine the effect on the visual outcome after macular hole s urgery when staining the internal limiting membrane (ILM) with indocyanine green (ICG) dye and to study the mechanism of the adverse effec...Objectives: To determine the effect on the visual outcome after macular hole s urgery when staining the internal limiting membrane (ILM) with indocyanine green (ICG) dye and to study the mechanism of the adverse effects. Patients and Metho ds: We studied 40 eyes of 38 patients with an idiopathic macular hole (size,< 0. 5 disc diameter; duration,< 12 months). The concentration, exposure time, and am ount of the ICG solution that was minimally required to make the ILM visible wer e determined. The patients were randomly divided into group 1 (20 eyes of 19 pat ients) who underwent ILM peeling without ICG staining, and group 2 (20 eyes of 19 patients) who underwent ILM peeling with ICG staining. Routine examinations were conducted during the 12-month follow-u p period. Multifocal electroretinogram, optical coherence tomography, and fluore scein angiography were performed on 31 eyes of 30 patients. Results: The macular hole was closed in all patients. Visual acuity was improved in both groups, but it was significantly better in group 1 (median, 0.85) than in group 2 (median, 0.60; P=0.02) after 12 months. The improvement of visual acuity in group 1 (loga rithm of the minimum angle of resolution log-MAR units SD, 0.82 0.19)was significantly better than that in group 2 (logMAR units, 0.67 0.21; P=0.30). T he multifocal electroretinogram and optical coherence tomographic findings were not significantly different in the 2 groups. Fluorescein angiogram showed only w eak hyperfluorescence at the macula in some patients of both groups. Conclusions : The results suggest that ICG staining should not be used as long as the visibi lity of the retinal surface is good. However, ICG staining may be acceptable at a low concentration when a clear view of the retinal surface is unattainable. Th e results of the multifocal electroretinogram, optical coherence tomography, and fluorescein angiography suggest that the differences in visual recovery were ca used not only by pigment epithelial cell damage or retinal toxic effect but also probably by the effect of ICG staining on ganglion cells and their axons.展开更多
文摘Background: This is a retrospective study designed to investigate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on diabetic macular edema in eyes that do not have a taut hyaloid and have been refractory to standard laser treatment. Methods: Review of 26 eyes of 20 patients consecutively were treated with PPV with ILM peel for refractory diabetic macular edema. Eyes were included if they had been unresponsive to conventional treatment defined as at least two focal laser applications by a retina specialist. Paired t- testing was performed to determine if a change in both optical coherence tomography (OCT)-Measured retinal thickness and logarithm of the minimum angle of resolution (logMAR) visual acuity occurred prior to and following PPV with epiretinal membrane vitrectomy. In addition, we performed multivariate regression analysis to determine if any clinical variables predicted a change in visual acuity. Results: The mean age in the sample was 65 years (range 29- 81 years). The mean follow-up time was 242 days (range35- 939). Sixteen of the 26 eyes were phakic and the remaining ten were pseudophakic. There was a statistically significant improvement of mean visual acuity from a preoperative logMAR vision of 1.0 to a best postoperative vision of 0.75 (P=0.016, paired t-test). Thirteen (50% ) of the 26 eyes gained at least two lines of best-corrected Snellen acuity, three (11.5% ) had a decline of at least two lines, and ten (38.5% ) showed stable visual acuity. Regression analysis demonstrated that baseline worse visual acuity was the only clinical variable that was associated with improvement in visual acuity (beta=0.602, P=0.016; R2=28.7). Fourteen eyes had preoperative and postoperative OCT. Thirteen eyes (93% )-had a significant decrease in foveal thickness; with an average preoperative thickness of 575 μ m compared to a postoperative average of 311 μ m (t=3.65, P=0.002). No surgical complications were observed during the follow-up period. Conclusions: Surgery for refractory diabetic edema without a taut hyaloid is associated with a significant improvement in visual acuity and diminution of retinal thickness as measured by OCT. Further investigations are warranted to define the role of surgery in the management of persistent diabeticmacular edema.
文摘Objectives: To determine the effect on the visual outcome after macular hole s urgery when staining the internal limiting membrane (ILM) with indocyanine green (ICG) dye and to study the mechanism of the adverse effects. Patients and Metho ds: We studied 40 eyes of 38 patients with an idiopathic macular hole (size,< 0. 5 disc diameter; duration,< 12 months). The concentration, exposure time, and am ount of the ICG solution that was minimally required to make the ILM visible wer e determined. The patients were randomly divided into group 1 (20 eyes of 19 pat ients) who underwent ILM peeling without ICG staining, and group 2 (20 eyes of 19 patients) who underwent ILM peeling with ICG staining. Routine examinations were conducted during the 12-month follow-u p period. Multifocal electroretinogram, optical coherence tomography, and fluore scein angiography were performed on 31 eyes of 30 patients. Results: The macular hole was closed in all patients. Visual acuity was improved in both groups, but it was significantly better in group 1 (median, 0.85) than in group 2 (median, 0.60; P=0.02) after 12 months. The improvement of visual acuity in group 1 (loga rithm of the minimum angle of resolution log-MAR units SD, 0.82 0.19)was significantly better than that in group 2 (logMAR units, 0.67 0.21; P=0.30). T he multifocal electroretinogram and optical coherence tomographic findings were not significantly different in the 2 groups. Fluorescein angiogram showed only w eak hyperfluorescence at the macula in some patients of both groups. Conclusions : The results suggest that ICG staining should not be used as long as the visibi lity of the retinal surface is good. However, ICG staining may be acceptable at a low concentration when a clear view of the retinal surface is unattainable. Th e results of the multifocal electroretinogram, optical coherence tomography, and fluorescein angiography suggest that the differences in visual recovery were ca used not only by pigment epithelial cell damage or retinal toxic effect but also probably by the effect of ICG staining on ganglion cells and their axons.
