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Shiraki A, Shiraki N, Sakimoto S, Maruyama K, Maeno T, Nishida K. Intraoperative challenges and management of fibrovascular membrane with tractional retinoschisis in proliferative diabetic retinopathy. BMC Ophthalmol 2024; 24:299. [PMID: 39033302 PMCID: PMC11264879 DOI: 10.1186/s12886-024-03555-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/03/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND In severe Proliferative Diabetic Retinopathy (PDR), fibrovascular membrane (FVM) causes macular tractional retinal detachment (MTRD) which threatens vision and eventually leads to blindness. Here we present a case of separation between the inner and outer retina in tractional retinoschisis, induced during intraoperative FVM delamination. CASE PRESENTATION A 68-year-old woman presented with PDR in the right eye, characterized by a combined FVM and retinal detachment, for which a vitrectomy was performed. Multiple holes, large retinal detachment extending to all quadrants, and white-lined blood vessels with FVM were found during the procedure. When membrane delamination was performed, it strayed into the space between the inner and outer retinal layers without being noticed due to retinoschisis and multiple retinal holes. After removing the FVM and detaching the separated inner retina, fluid-gas and photocoagulation were performed. Retinal reattachment was successfully achieved after surgery, and the postoperative visual acuity was improved and maintained for 26 months postoperatively. CONCLUSIONS When tractional retinoschisis due to FVM is combined with retinal holes in tractional retinal detachment (TRD), care must be taken to prevent delamination from straying into retinoschisis during separation.
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Affiliation(s)
- Akihiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- Department of Vision Informatics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takatoshi Maeno
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe), Osaka University, Suita, Osaka, Japan
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Hsieh YT, Yang CM. Vitreomacular traction in diabetic retinopathy. Jpn J Ophthalmol 2024; 68:12-18. [PMID: 38001367 DOI: 10.1007/s10384-023-01034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/22/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE Vitreomacular traction (VMT) has unique presentations in eyes with diabetic retinopathy (DR). This study aimed to investigate the characteristics and clinical course of VMT in DR. STUDY DESIGN A retrospective case series. METHODS Thirty eyes from 30 patients with DR and concurrent VMT were retrospectively enrolled. Baseline and final best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) characteristics were reported. Linear regression models were used to analyze the correlating factors for visual outcome. RESULTS Of the 30 eyes, a thickened posterior hyaloid membrane was noted in all cases and multi-layered traction from different directions in 14 eyes (46.7%). Twenty-one eyes (70%) had tractional macular retinoschisis, seven (23.3%) had foveal detachment, five (16.7%) had a lamellar macular hole, and three (10%) had a full-thickness macular hole, including two with macular hole retinal detachment. Three eyes had spontaneous release of the VMT within 3 months of observation. For the remaining 27 eyes receiving operations, the VMT, full-thickness macular hole, and serous foveal detachment all resolved postoperatively with residual macular schisis in 6 eyes (22.2%) only. None of the baseline OCT characteristics were associated with postoperative BCVA (P > .05). CONCLUSIONS VMT in DR had a thickened posterior hyaloid, and many of them had multi-layered traction and/or concurrent macular retinoschisis. Lamellar macular hole, full-thickness macular hole, or concurrent retinal detachment may also occur. Spontaneous resolution of VMT rarely occurred, and those who underwent operation for VMT had improved vision and macular structures with resolution of the macular hole and retinal detachment.
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Affiliation(s)
- Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
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Chen SN, Chen SJ, Wu TT, Wu WC, Yang CH, Yang CM. Refining vitrectomy for proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:3659-3670. [PMID: 37314522 PMCID: PMC10667443 DOI: 10.1007/s00417-023-06134-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Pars plana vitrectomy (PPV) is the main treatment modality for patients with severe diabetic retinopathy. With the development of systems for microincision, wide-angle viewing, digitally assisted visualization, and intraoperative optical coherence tomography, contemporary PPV for diabetic retinopathy has been performed on a wider range of indications than previously considered. In this article, we reviewed, in conjunction with our collective experiences with Asian patients, the applications of new technologies for PPV in eyes with diabetic retinopathy and highlighted several important procedures and entities not generally reiterated in the literature, in order for vitreoretinal surgeons to optimize their approaches when facing the challenges imposed by the complications in diabetic eyes.
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Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Tien Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- School of Medicine, National Taiwan University, Taipei, Taiwan.
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Tsui MC, Yang CM, Wang LC. Characteristics and outcomes of full-thickness macular holes created during vitrectomy for proliferative diabetic retinopathy. Int Ophthalmol 2023; 43:3479-3490. [PMID: 37277662 DOI: 10.1007/s10792-023-02753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the clinical features, management, and prognosis of full-thickness macular holes (FTMHs) inadvertently created during vitrectomy for eyes with proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP). METHODS Eyes with PDR and FVP that had intraoperatively created FTMHs were retrospectively collected as the study group, and age- and sex-matched subjects with PDR and FVP who did not have intraoperative FTMHs were selected as the control group. Fundus abnormalities, optical coherence tomography (OCT) features, and anatomical and functional outcomes were compared between the two groups. RESULTS Eleven eyes of 11 patients (5 male and 6 female) were identified as the study group. Follow-up duration was 36.8 ± 47.2 months. FTMHs were managed by ILM peeling or the inverted ILM flap technique. Anatomical success and MH closure were achieved in 100% of eyes in the study group. In comparison to the control group, the study group had a higher proportion of condensed prefoveal tissue (63.6% vs. 22.7%, p = 0.028), and a higher ratio of silicone oil tamponade (63.6% vs. 18.2%, p = 0.014), whereas there were no differences in preoperative and final BCVA, and the severity, activity, and locations of FVP between the two groups. CONCLUSION Condensed prefoveal tissue was a risk factor of FTMHs created during operation for eyes with PDR and FVP. The ILM peeling or the inverted ILM flap technique may be beneficial for the treatment with favorable anatomical and functional outcomes.
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Affiliation(s)
- Mei-Chi Tsui
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lu-Chun Wang
- Department of Ophthalmology, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliou, Yunlin, Taiwan.
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McCullough P, Mohite A, Virgili G, Lois N. Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2023; 141:186-195. [PMID: 36633878 PMCID: PMC9857853 DOI: 10.1001/jamaophthalmol.2022.5817] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/12/2022] [Indexed: 01/13/2023]
Abstract
Importance Tractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy (PPV) is the treatment of choice for TRD. Objective To determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD). Data Sources MEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened. Study Selection Eligible studies were those published in English, those reporting outcomes of PPV for dTRD, and those that included more than 25 eyes and with a minimum follow-up of 3 months. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction/synthesis were followed, and the National Institute for Health quality assessment tool was used to assess risk of bias. Study eligibility was determined independently by 2 reviewers; data extraction was conducted by 1 reviewer and entries checked for accuracy by another. Data were pooled using a random-effects model. Main Outcomes and Measures Main outcomes included rate of failure of retinal reattachment following 1 surgery and final visual acuity (VA). The association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated. Results Of the 406 studies identified, 38 (3839 eyes) were eligible and included for analysis. Patients had a median (IQR) age of 52.2 (49.6-55.7) years. In the studies reporting patient sex (31 of 38 studies), 1441 were female individuals (50.1%). The overall failure rate of retinal reattachment after 1 surgery was 5.9% (95% CI, 1.4%-8.3%), and the mean final VA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71). People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P <.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes. Conclusions and Relevance Results of this systematic review and meta-analysis suggest that PPV was an effective strategy to achieve retinal reattachment in people with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Overall, final postoperative VA remains low, and patients should be counseled on the guarded prognosis of dTRD.
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Affiliation(s)
- Philip McCullough
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Ajay Mohite
- Department of Ophthalmology, The Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Gianni Virgili
- Department of Ophthalmology, The Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Department of Ophthalmology, The Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Gomułka K, Ruta M. The Role of Inflammation and Therapeutic Concepts in Diabetic Retinopathy-A Short Review. Int J Mol Sci 2023; 24:ijms24021024. [PMID: 36674535 PMCID: PMC9864095 DOI: 10.3390/ijms24021024] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Diabetic retinopathy (DR) as a microangiopathy is the most common complication in patients with diabetes mellitus (DM) and remains the leading cause of blindness among adult population. DM in its complicated pathomechanism relates to chronic hyperglycemia, hypoinsulinemia, dyslipidemia and hypertension-all these components in molecular pathways maintain oxidative stress, formation of advanced glycation end-products, microvascular changes, inflammation, and retinal neurodegeneration as one of the key players in diabetes-associated retinal perturbations. In this current review, we discuss the natural history of DR with special emphasis on ongoing inflammation and the key role of vascular endothelial growth factor (VEGF). Additionally, we provide an overview of the principles of diabetic retinopathy treatments, i.e., in laser therapy, anti-VEGF and steroid options.
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Affiliation(s)
- Krzysztof Gomułka
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, ul. M. Curie-Skłodowskiej 66, 50-369 Wrocław, Poland
- Correspondence:
| | - Michał Ruta
- Clinical Department of Ophthalmology, 4th Military Clinical Hospital with Polyclinic, ul. Rudolfa Weigla 5, 50-981 Wrocław, Poland
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Peripapillary retinoschisis associated with glaucomatous optic neuropathy (clinical cases). OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov107586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Peripapillary retinoschisis is a rare condition and is detected more often in patients with glaucoma or glaucoma suspects, while data on the pathophysiological mechanisms of development and the effect on the course of glaucoma are limited. The article presents two clinical cases of unilateral peripapillary retinoschisis detected accidentally during a routine examination of patients with glaucoma.
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8
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Lin A, Xia H, Zhang A, Liu X, Chen H. Vitreomacular Interface Disorders in Proliferative Diabetic Retinopathy: An Optical Coherence Tomography Study. J Clin Med 2022; 11:3266. [PMID: 35743337 PMCID: PMC9224563 DOI: 10.3390/jcm11123266] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
Vitreomacular interface plays an important role in the pathogenesis and progression of proliferative diabetic retinopathy (PDR). This study investigated the prevalence and risk factors of vitreomacular interface disorders (VMID) in PDR. The macular optical coherence tomography (OCT) scans of 493 eyes from 378 PDR patients were retrospectively reviewed to detect VMID, including vitreomacular adhesion (VMA), vitreomacular traction (VMT), epiretinal membrane (ERM), lamellar hole-associated epiretinal proliferation (LHEP), and macular hole (MH). The associations between VMID and baseline factors, intraretinal structure, and visual acuity were analyzed. The prevalence was 78.9% for ERM, 13.4% for VMT, 4.8% for MH, 2.2% for LHEP, and 2.0% for VMA, respectively. On multivariable analyses (odds ratio, 95% confidence interval), fibrovascular proliferation (FVP) was positively associated with MH (8.029, 1.873-34.420), VMT (3.774, 1.827-7.798), and ERM (2.305, 1.460-3.640). High-risk PDR was another risk factor of ERM (1.846, 1.101-3.090). Female gender was positively associated with MH (3.836, 1.132-13.006), while vitreous hemorrhage was negatively associated with MH (0.344, 0.133-0.890). Eyes with all VMID subtypes showed more frequent macular cysts and tractional retinal detachment with poorer visual acuity (p ≤ 0.001). Therefore, the prevalence of VMID was considerably high, indicating that this distinct entity should be considered in interventions for PDR.
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Affiliation(s)
- Aidi Lin
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, China
| | | | | | | | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, Shantou 515041, China
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9
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Full-thickness macular hole formation in proliferative diabetic retinopathy. Sci Rep 2021; 11:23839. [PMID: 34903770 PMCID: PMC8668955 DOI: 10.1038/s41598-021-03239-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/30/2021] [Indexed: 01/15/2023] Open
Abstract
Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT) available before and after full-thickness macular hole (FTMH) formation were retrospectively reviewed. Four types of FTMH formation pathways in PDR were identified and were quite different from those in idiopathic conditions. The activity, severity and locations of FVP varied in PDR eyes destined to develop FTMHs. Type 1 was characterized by epiretinal membrane (ERM) and/or vitreomacular traction (VMT) inducing foveoschisis, intraretinal cysts or foveal detachment, followed by formation of a FTMH or macular hole retinal detachment (MHRD). In type 2, ERM and/or FVP induced lamellar macular hole (LMH) with foveoschisis, followed by the formation of FTMH or MHRD. Type 3 was characterized by the initial tractional retinal detachment (TRD) with foveal cysts and/or foveoschisis and the subsequent formation of MHRD. Type 4 was characterized by TRD associated with foveal thinning, ensued by the formation of MHRD. The severity of FVP was grade 2 in 66.7% of eyes in both types 1 and 4, and grade 3 in 75% of eyes in type 3 while the severity of FVP was more evenly distributed in type 2.
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10
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Russell JF, Scott NL, Townsend JH, Shi Y, Gregori G, Crane AM, Flynn HW, Sridhar J, Rosenfeld PJ. WIDE-FIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF DIABETIC TRACTIONAL RETINAL DETACHMENTS BEFORE AND AFTER SURGICAL REPAIR. Retina 2021; 41:1587-1596. [PMID: 34397964 PMCID: PMC8369041 DOI: 10.1097/iae.0000000000003146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Wide-field (WF) swept-source (SS) optical coherence tomography angiography (SS-OCTA) was used to image diabetic tractional retinal detachments (TRDs) before and after pars plana vitrectomy. The clinical utility of SS-OCTA was assessed. METHODS Patients with diabetic TRDs were imaged prospectively with SS-OCTA. Ultrawide-field imaging was obtained when possible. Postoperative WF SS-OCTA imaging was performed. RESULTS From January 2018 through December 2019, 31 eyes of 21 patients with diabetic TRDs were imaged. Wide-field SS-OCTA en-face images captured all areas of TRD and fibrovascular proliferation within the posterior pole that were visualized on ultrawide-field imaging. Optical coherence tomography angiography B-scans revealed the vascularity of preretinal membranes and identified areas of vitreoretinal traction and posterior vitreous detachment. Ten eyes underwent pars plana vitrectomy. Postoperative SS-OCTA imaging demonstrated removal of fibrovascular membranes, relief of traction, and resolution of TRDs. Retinal ischemia before and after surgical repair appeared similar. CONCLUSION All clinically relevant features of diabetic TRDs were identified at baseline and assessed longitudinally after pars plana vitrectomy using WF SS-OCTA, which showed resolution of vitreoretinal traction and no apparent change in the status of retinal perfusion after surgery. If the media are clear and fixation is adequate, WF SS-OCTA is likely the only imaging modality needed for the diagnosis and longitudinal evaluation of diabetic TRDs.
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Affiliation(s)
- Jonathan F. Russell
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Nathan L. Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Justin H. Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ashley M. Crane
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Abstract
PURPOSE To describe the clinical features and surgical outcomes of diabetic retinopathy-associated lamellar macular hole and compare them with those of idiopathic lamellar macular hole. METHODS A total of 17 eyes with diabetic retinopathy-associated lamellar macular hole and 30 eyes with idiopathic lamellar macular hole undergoing surgery were retrospectively enrolled. Baseline best-corrected visual acuity, preoperative optical coherence tomography characteristics, and final best-corrected visual acuity were compared between two groups. RESULTS Both the baseline and the final best-corrected visual acuity in the diabetic retinopathy group were significantly worse than those in the idiopathic group (p = 0.029 for baseline, p = 0.002 for final). Lamellar macular hole in diabetic retinopathy tended to have a wider opening (p < 0.001) and a thinner residual base (p = 0.023). The width and height of parafoveal schisis in diabetic retinopathy-associated lamellar macular hole were both larger than those in idiopathic lamellar macular hole (p < 0.001 for both). After operation, both groups achieved significant improvement in best-corrected visual acuity (p < 0.01 for both). CONCLUSION Compared with idiopathic group, diabetic retinopathy-associated lamellar macular hole had worse baseline best-corrected visual acuity, wider defect, and more pronounced parafoveal schisis. However, significant visual improvement could be obtained after operation. All cases in both groups achieved good anatomical outcomes with normalization of foveal contour and reduction of parafoveal schisis.
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Affiliation(s)
- Bo-I Kuo
- Department of Ophthalmology, National Taiwan University Hospital, Taipei.,Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei.,College of Medicine, National Taiwan University, Taipei
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei
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12
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Iyer SSR, Regan KA, Burnham JM, Chen CJ. Surgical management of diabetic tractional retinal detachments. Surv Ophthalmol 2019; 64:780-809. [PMID: 31077688 DOI: 10.1016/j.survophthal.2019.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
Abstract
Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. We review the literature related to the management of this disease. Preoperative planning includes appropriate patient selection, diagnostic and prognostic imaging, and medical optimization with reduction of systemic risk factors. Use of antivascular endothelial growth factor for preoperative treatment has had significant benefits for tractional retinal detachment repair in improving surgical efficiency and outcomes. Advances in microsurgical instrumentation are discussed, with attention to small-gauge vitrectomy with improved flow dynamics, viewing strategies, and lighting allowing bimanual surgery. Special emphasis is placed on bimanual surgical technique, choice of tamponade, and the avoidance of iatrogenic damage. Complications and special considerations are further explored. Based on our compilation of relevant literature, we propose a surgical algorithm for the management of these complex patients.
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Affiliation(s)
- Siva S R Iyer
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.
| | - Kathleen A Regan
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Ching J Chen
- Department of Ophthalmology, University of Mississippi School of Medicine, Jackson, Mississippi, USA
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13
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Stewart MW, Browning DJ, Landers MB. Current management of diabetic tractional retinal detachments. Indian J Ophthalmol 2019; 66:1751-1762. [PMID: 30451175 PMCID: PMC6256889 DOI: 10.4103/ijo.ijo_1217_18] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Twenty-five percent of diabetes-related vision loss stems from complications of proliferative diabetic retinopathy (PDR). Panretinal photocoagulation has been the preferred treatment of high-risk PDR for decades and more recently intravitreal injections of drugs that inhibit the actions of vascular endothelial growth factor have become popular. But despite these treatments PDR may progress uncontrollably to advanced pathologies such as traction retinal detachments (TRDs), combined traction/rhegmatogenous retinal detachments (TRD/RRDs), vitreous hemorrhages, rubeosis iridis, and traction maculopathies, which produce mild-to-severe loss of vision. TDR have long been the most common indication for PDR-related vitreoretinal surgery. Vitrectomy surgery is indicated for recent (<6 months duration) TRD involving the macula, progressive TRD that threatens the macula, and recent data suggest that chronic macula-involving TRDs (>6 months duration) may also benefit. Combined TRD/RRD represents a particularly challenging surgical condition but advances in surgical instrumentation, dissection techniques, and post-operative tamponade have produced excellent success rates. The recent development of small-gauge vitrectomy systems has persuaded most surgeons to switch platforms since these appear to produce shorter surgical times and quicker post-operative recoveries. Pre-operative injections of bevacizumab are frequently administered for persistent neovascularization to facilitate surgical dissection of pre-retinal fibrosis and reduce the incidence of post-operative hemorrhages. Recent trends toward earlier surgical intervention and expanded indications are likely to continue as surgical instrumentation and techniques are further developed.
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Affiliation(s)
| | - David J Browning
- Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC, USA
| | - Maurice B Landers
- Department of Ophthalmology, Kittner Eye Center, University of North Carolina, Chapel Hill, NC, USA
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NONHEREDITARY IDIOPATHIC FOVEAL RETINOSCHISIS ASSOCIATED WITH NEW-ONSET PROLIFERATIVE DIABETIC RETINOPATHY. Retin Cases Brief Rep 2017; 14:232-234. [PMID: 29176525 DOI: 10.1097/icb.0000000000000682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To present a case of idiopathic foveal retinoschisis in a patient with new-onset proliferative diabetic retinopathy. METHODS Single case report. RESULTS A 64-year-old African American man with Type 2 diabetes mellitus presented for a routine annual diabetic eye examination with mildly blurred vision at near and distance in the right eye. Fluorescein angiography demonstrated optic nerve leakage consistent with neovascularization of the disk but no leakage on or around the macula in the right eye. Optical coherence tomography demonstrated peripapillary macular retinoschisis within the outer plexiform layer without optic disk pit, epiretinal membrane, or diabetic tractional membrane. He underwent pan-retinal photocoagulation in the right eye; his acuity and schisis remained unchanged at 6-month follow-up. CONCLUSION This is the first reported case of idiopathic acquired macular schisis with new-onset nontractional proliferative diabetic retinopathy in the same eye.
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Sharma T, Fong A, Lai TY, Lee V, Das S, Lam D. Surgical treatment for diabetic vitreoretinal diseases: a review. Clin Exp Ophthalmol 2016; 44:340-54. [PMID: 27027299 DOI: 10.1111/ceo.12752] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 01/26/2023]
Abstract
Over the past four decades, advancements in surgical instrumentations and techniques have significantly improved the postoperative anatomical and visual outcomes of patients with various diabetic vitreoretinal diseases. In particular, surgical interventions for previously serious and untreatable blinding proliferative diabetic retinopathy can now be performed, with much better results. The advents of micro incisional vitrectomy system with better visualization system like binocular indirect ophthalmomicroscope and state-of-the-art instrumentation revolutionized the era of diabetic vitrectomy. High-speed vitrectors, finer instruments, chromo-assisted vitrectomy and use of anti-vascular endothelial growth factors not only change the paradigm but also help achieve much better outcome after diabetic vitrectomies. In this review, we will discuss and summarize the indications, surgical considerations, surgical techniques, potential complications and outcomes of vitreoretinal surgery for diabetic eye diseases.
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Affiliation(s)
- Tarun Sharma
- Sankara Nethralaya (Main Campus), Chennai, Tamil Nadu, India
| | - Angie Fong
- Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Timothy Y Lai
- 2010 Eye & Cataract Centre, TsimShaTsui, Kowloon, Hong Kong
| | - Vincent Lee
- Dennis Lam & Partners Eye Center, Central, Hong Kong
| | - Sudipta Das
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China
| | - Dennis Lam
- Dennis Lam & Partners Eye Center, Central, Hong Kong.,C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China
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Kim YC, Shin JP. Spectral-domain optical coherence tomography findings of tractional retinal elevation in patients with diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2015; 254:1481-1487. [PMID: 26542121 DOI: 10.1007/s00417-015-3206-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/05/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the clinical and morphological characteristics as well as the surgical outcomes of tractional retinal elevation (TRE) in patients with proliferative diabetic retinopathy (PDR) by analyzing spectral-domain optical coherence tomography (SD-OCT). METHODS SD-OCT images of 26 eyes (24 patients) who visited our clinic because of TRE and PDR from August 2011 to August 2014 were reviewed. According to the presence or absence of tractional retinal detachment (TRD), patients were classified into group 1 (without TRD) or group 2 (with TRD), and the clinical characteristics and surgical outcomes of the two groups were compared. Furthermore, we categorized the SD-OCT morphological components into sponge, cystoid, saw tooth, bridging columnar, and TRD and compared the characteristics among patients who had different components. RESULTS Group 1 had 18 eyes and group 2 had eight eyes. No differences in age, best corrected visual acuity (BCVA), or spherical equivalent were observed between the two groups, but group 2 had longer axial length than that of group 1 (p = 0.02). A large variety of combined OCT findings was found in group 1 compared to that in group 2. TRD was the least combined form with the other morphological components. Although 92 % of eyes with the bridging columnar component had the cystoid component, TRD and tractional retinoschisis (TRS, bridging columnar morphology) were combined in only one eye. CONCLUSION Diabetic TRE may progress to TRD or TRS, which are mutually exclusive. They may progress to TRD in eyes with a long axial length, and cystoid macular edema seems to develop into TRS.
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Affiliation(s)
- Yu Cheol Kim
- Department of Ophthalmology, Keimyung University School of Medicine Dongsan Medical Center, 56, Dalseong-ro, Jung-gu, Daegu, 41931, Korea.
| | - Jae Pil Shin
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
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Chao DL, Flynn HW. Stability of macular traction in involutional diabetic retinopathy over a 5-year course. Ophthalmic Surg Lasers Imaging Retina 2015; 46:131-3. [PMID: 25559526 DOI: 10.3928/23258160-20150101-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/10/2014] [Indexed: 11/20/2022]
Abstract
Involutional diabetic retinopathy is a descriptive term for an end-stage phase of proliferative diabetic retinopathy (PDR), which is often non-progressive. Two patients with involutional PDR with nonprogressive macular traction documented by spectral-domain optical coherence tomography (SD-OCT) over a 5-year period are described in this report.
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