Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy
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)
- et al.
The role of the vitreous in diabetic macular edema
Ophthalmology
(1988) - et al.
Modified grid laser photocoagulation for diffuse diabetic macular edemalong-term visual results
Ophthalmology
(1991) - et al.
Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction
Ophthalmology
(1992) - et al.
Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane
Am J Ophthalmol
(1996) - et al.
Vitrectomy for diffuse macular edema in cases of diabetic retinopahy
Am J Ophthalmol
(1996) - et al.
Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid
Am J Ophthalmol
(2000) - et al.
Tomographic assessment of vitreous surgery for diabetic macular edema
Am J Ophthalmol
(2000) - et al.
Vitrectomy for diabetic macular edemathe role of posterior vitreous detachment and epimacular membrane
Am J Ophthalmol
(2001) - et al.
The foveal cyst as the first step in macular hole formation. A prospective study by optical coherence tomography
Ophthalmology
(2001) - et al.
Macular traction and diabetic macular edema associated with posterior hyaloidal traction
Am J Ophthalmol
(2001)
Diabetic macular edema. A review
Ophthalmology
Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus
Ophthalmology
Early Treatment Diabetic Retinopathy Study report no.1photocoagulation for diabetic macular edema
Arch Ophthalmol
Oedèmes maculaires induits par la contraction de la hyaloïde postérieure
J Fr Ophtalmol
Vitrectomy for diabetic macular edema with a taut premacular posterior hyaloid
Curr Opin Ophthalmol
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2017, Canadian Journal of OphthalmologyCitation 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.