Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Published in:

01-10-2012 | Retinal Disorders

External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy

Authors: Jay Kumar Chhablani, Jae Suk Kim, Lingyun Cheng, Igor Kozak, William Freeman

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 10/2012

Abstract

Background

To evaluate the predictors of visual improvement using spectral-domain optical coherence tomography (SD-OCT) in eyes with resistant diabetic macular edema (DME) treated with pars plana vitrectomy.

Methods

Thirty-four eyes with resistant DME were evaluated in a retrospective manner. Several SD-OCT variables including photoreceptor inner segment/outer segment (IS/OS) junction, external limiting membrane (ELM) integrity, and central macular thickness (CMT) before and after the surgery, were evaluated by two experienced observers, masked to visual acuity. The visual improvement was used as the outcome measure for a stepwise regression, while the OCT factors were used as predictors.

Results

The strongest predictor of vision improvement was pre-operative damage to the ELM (p = 0.0277) compared to IS/OS junction (p = 0.03). Pretreatment central macular thickness was a very weak predictor (p = 0.18) of visual improvement. For each percentage increase of ELM integrity there was a 0.13 letter gain in vision. ELM integrity explained 16% of the visual acuity improvement after treatment, which rose to 21% with the addition of CMT. The addition of IS/OS junction in the model did not add predictive information.

Conclusions

Evaluation of ELM preoperatively predicts the vision improvement more accurately than the IS/OS junction and CMT in eyes with DME.

Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report number 1. Arch Ophthalmol 103(12):1796–1806CrossRef

Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, Baumal C (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109(5):920–927PubMedCrossRef

Nicholson BP, Schachat AP (2010) A review of clinical trials of anti-VEGF agents for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 248(7):915–930PubMedCrossRef

Capone A Jr, Panozzo G (2000) Vitrectomy for refractory diabetic macular edema. Semin Ophthalmol 15(2):78–80PubMedCrossRef

Shah SP, Patel M, Thomas D, Aldington S, Laidlaw DA (2006) Factors predicting outcome of vitrectomy for diabetic macular oedema: results of a prospective study. Br J Ophthalmol 90(1):33–36PubMedCrossRef

Otani T, Kishi S (2002) A controlled study of vitrectomy for diabetic macular edema. Am J Ophthalmol 134(2):214–219PubMedCrossRef

Otani T, Yamaguchi Y, Kishi S (2010) Correlation between visual acuity and foveal microstructural changes in diabetic macular edema. Retina 30(5):774–780PubMedCrossRef

Maheshwary AS, Oster SF, Yuson RM, Cheng L, Mojana F, Freeman WR (2010) The association between percent disruption of the photoreceptor inner segment-outer segment junction and visual acuity in diabetic macular edema. Am J Ophthalmol 150(1):63–67, e61PubMedCrossRef

Chylack LT Jr, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, Friend J, McCarthy D, Wu SY (1993) The lens opacities classification system III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol 111(6):831–836PubMedCrossRef

10.

Blumenkranz MS, Haller JA, Kuppermann BD, Williams GA, Ip M, Davis M, Weinberg DV, Chou C, Whitcup SM (2010) Correlation of visual acuity and macular thickness measured by optical coherence tomography in patients with persistent macular edema. Retina 30(7):1090–1094PubMedCrossRef

11.

Browning DJ, Glassman AR, Aiello LP, Beck RW, Brown DM, Fong DS, Bressler NM, Danis RP, Kinyoun JL, Nguyen QD, Bhavsar AR, Gottlieb J, Pieramici DJ, Rauser ME, Apte RS, Lim JI, Miskala PH (2007) Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology 114(3):525–536PubMedCrossRef

12.

Eandi CM, Chung JE, Cardillo-Piccolino F, Spaide RF (2005) Optical coherence tomography in unilateral resolved central serous chorioretinopathy. Retina 25(4):417–421PubMedCrossRef

13.

Murakami T, Tsujikawa A, Ohta M, Miyamoto K, Kita M, Watanabe D, Takagi H, Yoshimura N (2007) Photoreceptor status after resolved macular edema in branch retinal vein occlusion treated with tissue plasminogen activator. Am J Ophthalmol 143(1):171–173PubMedCrossRef

14.

Piccolino FC, de la Longrais RR, Ravera G, Eandi CM, Ventre L, Abdollahi A, Manea M (2005) The foveal photoreceptor layer and visual acuity loss in central serous chorioretinopathy. Am J Ophthalmol 139(1):87–99PubMedCrossRef

15.

Schocket LS, Witkin AJ, Fujimoto JG, Ko TH, Schuman JS, Rogers AH, Baumal C, Reichel E, Duker JS (2006) Ultrahigh-resolution optical coherence tomography in patients with decreased visual acuity after retinal detachment repair. Ophthalmology 113(4):666–672PubMedCrossRef

16.

Sakamoto A, Nishijima K, Kita M, Oh H, Tsujikawa A, Yoshimura N (2009) Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 247(10):1325–1330PubMedCrossRef

17.

Bunt-Milam AH, Saari JC, Klock IB, Garwin GG (1985) Zonulae adherentes pore size in the external limiting membrane of the rabbit retina. Invest Ophthalmol Vis Sci 26(10):1377–1380PubMed

18.

Wakabayashi T, Oshima Y, Fujimoto H, Murakami Y, Sakaguchi H, Kusaka S, Tano Y (2009) Foveal microstructure and visual acuity after retinal detachment repair: imaging analysis by Fourier-domain optical coherence tomography. Ophthalmology 116(3):519–528PubMedCrossRef

19.

Wakabayashi T, Fujiwara M, Sakaguchi H, Kusaka S, Oshima Y (2010) Foveal microstructure and visual acuity in surgically closed macular holes: spectral-domain optical coherence tomographic analysis. Ophthalmology 117(9):1815–1824PubMedCrossRef

20.

Oishi A, Hata M, Shimozono M, Mandai M, Nishida A, Kurimoto Y (2010) The significance of external limiting membrane status for visual acuity in age-related macular degeneration. Am J Ophthalmol 150(1):27–32, e21PubMedCrossRef

21.

Yamaike N, Tsujikawa A, Ota M, Sakamoto A, Kotera Y, Kita M, Miyamoto K, Yoshimura N, Hangai M (2008) Three-dimensional imaging of cystoid macular edema in retinal vein occlusion. Ophthalmology 115(2):355–362, e352PubMedCrossRef

Title: External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy
Authors: Jay Kumar Chhablani
Jae Suk Kim
Lingyun Cheng
Igor Kozak
William Freeman
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 10/2012
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-012-1968-x

At a glance: The STEP trials

Springer Medicine

External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2012

IOL Power by Kenneth J Hoffer. 257 pp 2011 ISBN: 978-1-55642-988-0 Slack Incorporated

Spontaneous orbital haemorrhage in a healthy young male

EXTEND III: Efficacy and safety of ranibizumab in South Korean and Taiwanese patients with subfoveal CNV secondary to AMD

IL-10 -1082 SNP and IL-10 in primary CNS and vitreoretinal lymphomas

Reproducibility of nearwork-induced transient myopia measurements using the WAM-5500 autorefractor in its dynamic mode

Cytoprotective effect of hyaluronic acid and hydroxypropyl methylcellulose against DNA damage induced by thimerosal in Chang conjunctival cells