Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy

https://doi.org/10.1016/S0002-9394(02)01837-8Get rights and content

Abstract

Purpose

To report the use of optical coherence tomography (OCT) for evaluation of diffuse diabetic macular edema (DME) before and after vitrectomy.

Design

Interventional case series.

Methods

A retrospective study was made of 15 consecutive eyes of 13 patients that had vitrectomy for diffuse DME and OCT preoperatively and postoperatively. In seven eyes of six patients (group 1), vitrectomy was performed because of vitreomacular traction observed on biomicroscopy or OCT. In the other eight eyes of seven patients (group 2), vitrectomy was performed for DME not responsive to laser photocoagulation, with no vitreomacular traction on biomicroscopy or OCT.

Results

Mean ± standard deviation (SD) follow-up after vitrectomy was 18 ± 10 months (range, 6 to 33 months). In group 1, mean ± SD retinal thickness decreased significantly from 661 ± 181 μm preoperatively to 210 ± 32 μm at the end of follow-up (P = .018). Median best-corrected visual acuity (BCVA) improved from 20/100 before surgery (range, 20/250 to 20/50) to 20/80 at the end of follow-up (range, 20/250 to 20/25; P = .046). In one eye in group 1, vitreomacular traction was only observed on OCT and not on biomicroscopy. In group 2, mean ± SD retinal thickness decreased from 522 ± 103 μm preoperatively to 428 ± 121 μm at the end of follow-up (P = .2). Median BCVA was 20/100 before vitrectomy (range, 20/320 to 20/63) and 20/200 at the end of follow-up (range, 20/250 to 20/63; P = .78).

Conclusions

Vitrectomy was beneficial in eyes with diffuse DME combined with vitreomacular traction but not in eyes without traction. Optical coherence tomography allowed diagnosis of subtle vitreomacular traction and provided precise preoperative and postoperative assessments of macular thickness.

Section snippets

Design

In this interventional case series, we retrospectively reviewed the data for 15 consecutive eyes of 13 patients (nine men and four women) who underwent vitrectomy for diffuse DME between June 1998 and April 2001 and OCT preoperatively and postoperatively .

Methods

In seven eyes of six patients (group 1), vitrectomy was performed because vitreomacular traction was observed on biomicroscopy or OCT. In the other eight eyes of seven patients (group 2), the indication for vitrectomy was clinically significant diffuse DME unresponsive to laser photocoagulation with no signs of PVD or vitreomacular traction on biomicroscopy. In this group, the posterior hyaloid was either not visible at all on OCT or exhibited unremarkable shallow perifoveal detachment while

Results

On OCT, all the seven eyes in group 1 exhibited a particular preoperative appearance suggestive of vitreomacular traction. We called this condition tractional diabetic macular edema (TDME, FIGURE 1, FIGURE 2). On OCT, the macular profile was characterized by macular thickening with loss of the foveal depression in all cases, and swelling of the outer retinal layers. The posterior hyaloid on OCT was thick and hyperreflective; it was partially detached from the posterior pole and taut over it

Discussion

Since 1990, several authors have reported that vitrectomy is beneficial for diffuse DME combined with a taut thickened posterior hyaloid.5, 6, 7, 9, 11, 12 Others have also shown that vitrectomy may be useful, even in the absence of obvious posterior hyaloid anomalies.8, 10, 13, 14, 16, 17 In these studies, the vitreomacular relationship and DME were assessed by biomicroscopy, which unlike OCT was shown to be insufficiently accurate to determine the status of the posterior hyaloid when it is

References (31)

  • G.H. Bresnick

    Diabetic macular edema. A review

    Ophthalmology

    (1986)
  • T. Hikishi et al.

    Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus

    Ophthalmology

    (1997)
  • Early Treatment Diabetic Retinopathy Study report no.1photocoagulation for diabetic macular edema

    Arch Ophthalmol

    (1985)
  • G. Van Effenterre et al.

    Oedèmes maculaires induits par la contraction de la hyaloïde postérieure

    J Fr Ophtalmol

    (1993)
  • S.D. Pendergast

    Vitrectomy for diabetic macular edema with a taut premacular posterior hyaloid

    Curr Opin Ophthalmol

    (1998)
  • Cited by (200)

    • A review of methods for automatic detection of macular edema

      2021, Biomedical Signal Processing and Control
    • The Fovea: Structure, Function, Development, and Tractional Disorders

      2021, The Fovea: Structure, Function, Development, and Tractional Disorders
    • Surgical Treatment of Diabetic Retinopathy

      2018, Current Management of Diabetic Retinopathy
    • Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy

      2017, Canadian Journal of Ophthalmology
      Citation Excerpt :

      With improvements in resolution and widespread availability of OCT, imaging of the diabetic macular vitreoretinal interface is identifying many cases of macular traction that are not clinically apparent. Some authors have suggested that the benefit of vitrectomy may be confined to patients with OCT signs suggestive of macular traction.245,246 The DRCRnet reported a study of 87 eyes with DME and vitreomacular traction that underwent vitrectomy.

    View all citing articles on Scopus
    View full text