Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Japanese Journal of Ophthalmology
Published in: Japanese Journal of Ophthalmology 4/2015

01-07-2015 | Clinical Investigation

Macular morphologic findings on optical coherence tomography after microincision vitrectomy for proliferative diabetic retinopathy

Authors: Tomoaki Murakami, Akihito Uji, Ken Ogino, Noriyuki Unoki, Shin Yoshitake, Yoko Dodo, Takahiro Horii, Kazuaki Nishijima, Nagahisa Yoshimura

Published in: Japanese Journal of Ophthalmology | Issue 4/2015

Login to get access

Abstract

Purpose

To investigate macular morphology on spectral-domain optical coherence tomography (SD-OCT) images after microincision vitrectomy for vitreous hemorrhage associated with proliferative diabetic retinopathy (PDR).

Methods

In this retrospective case series, 69 eyes (57 consecutive patients) that underwent 23-gauge microincision vitrectomy for vitreous hemorrhage due to PDR were investigated. Qualitative and quantitative characteristics on SD-OCT images [central retinal thickness, external limiting membrane (ELM), and the ellipsoid zone, epiretinal membranes involving the fovea, and hyperreflective foci at the fovea] were assessed 6 months postoperatively. Their association with the logarithm of the minimum angle of resolution visual acuity (logMAR VA) was evaluated.

Results

The ELM was disrupted in 15 and the ellipsoid zone in 27 eyes, and associated significantly (P < 0.001, for both comparisons) with poor visual outcomes 6 months postoperatively. Hyperreflective foci in the outer retinal layers were associated with either a disrupted ELM or ellipsoid zone and poor prognoses (P < 0.001, for all comparisons). The accumulation of hyperreflective foci at the fovea in five eyes was correlated significantly (P < 0.001) with poorer logMAR VA. Twenty-nine eyes had center-involved diabetic macular edema 6 months postoperatively, whereas the central thickness was not correlated with the logMAR VA (R = −0.148, P = 0.224). Eight eyes with either epiretinal membrane on SD-OCT images had greater central thickness (P = 0.003), although there were no differences in the logMAR VA between eyes with and without it (P = 0.648).

Conclusions

Foveal photoreceptor damage is associated with poor visual outcomes after microincision vitrectomy for vitreous hemorrhage due to PDR.
Literature
1.
Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984;102:527–32.PubMedCrossRef
2.
Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35:556–64.PubMedCentralPubMedCrossRef
3.
Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994;331:1480–7.PubMedCrossRef
4.
Adamis AP, Miller JW, Bernal MT, D’Amico DJ, Folkman J, Yeo TK, et al. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy. Am J Ophthalmol. 1994;118:445–50.PubMedCrossRef
5.
Preliminary report on effects of photocoagulation therapy. The Diabetic Retinopathy Study Research Group. Am J Ophthalmol. 1976;81:383–96.
6.
7.
Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA. 2007;298:902–16.PubMedCrossRef
8.
Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study (DRVS) report #1. Ophthalmology. 1985;92:492–502.
9.
Ho T, Smiddy WE, Flynn HW Jr. Vitrectomy in the management of diabetic eye disease. Surv Ophthalmol. 1992;37:190–202.PubMedCrossRef
10.
Gandorfer A, Kampik A. Pars plana vitrectomy in diabetic retinopathy. From pathogenetic principle to surgical strategy. Ophthalmologe. 2000;97:325–30 (in German).PubMedCrossRef
11.
Helbig H, Sutter FK. Surgical treatment of diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2004;242:704–9.PubMedCrossRef
12.
Ahn J, Woo SJ, Chung H, Park KH. The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy. Ophthalmology. 2011;118:2218–26.PubMedCrossRef
13.
Zhao LQ, Zhu H, Zhao PQ, Hu YQ. A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy. Br J Ophthalmol. 2011;95:1216–22.PubMedCentralPubMedCrossRef
14.
Helbig H, Kellner U, Bornfeld N, Foerster MH. Rubeosis iridis after vitrectomy for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 1998;236:730–3.PubMedCrossRef
15.
Novak MA, Rice TA, Michels RG, Auer C. Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology. 1984;91:1485–9.PubMedCrossRef
16.
Tardif YM, Schepens CL. Closed vitreous surgery: XV. Fibrovascular ingrowth from the pars plana sclerotomy. Arch Ophthalmol. 1977;95:235–9.PubMedCrossRef
17.
Fujii GY, De Juan E, Jr, Humayun, Pieramici DJ, Chang TS, Awh C, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109(10):1807–12 (discussion 13).PubMedCrossRef
18.
19.
Shimada H, Nakashizuka H, Mori R, Mizutani Y. Expanded indications for 25-gauge transconjunctival vitrectomy. Jpn J Ophthalmol. 2005;49:397–401.PubMedCrossRef
20.
Gosse E, Newsom R, Lochhead J. The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy. Eye (Lond). 2012;26:140–3.PubMedCentralPubMedCrossRef
21.
Cha DM, Woo SJ, Park KH, Chung H. Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2013;251(6):1469–74.PubMedCrossRef
22.
Hee MR, Puliafito CA, Duker JS, Reichel E, Coker JG, Wilkins JR, et al. Topography of diabetic macular edema with optical coherence tomography. Ophthalmology. 1998;105:360–70.PubMedCentralPubMedCrossRef
23.
Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999;127:688–93.PubMedCrossRef
24.
Murakami T, Nishijima K, Sakamoto A, Ota M, Horii T, Yoshimura N. Association of pathomorphology, photoreceptor status, and retinal thickness with visual acuity in diabetic retinopathy. Am J Ophthalmol. 2011;151:310–7.PubMedCrossRef
25.
Browning DJ, Glassman AR, Aiello LP, Beck RW, Brown DM, Fong DS, et al. Relationship between optical coherence tomography–measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology. 2007;114:525–36.PubMedCrossRef
26.
Spaide RF, Curcio CA. Anatomical correlates to the bands seen in the outer retina by optical coherence tomography: literature review and model. Retina. 2011;31:1609–19.PubMedCentralPubMedCrossRef
27.
Murakami T, Tsujikawa A, Ohta M, Miyamoto K, Kita M, Watanabe D, et al. Photoreceptor status after resolved macular edema in branch retinal vein occlusion treated with tissue plasminogen activator. Am J Ophthalmol. 2007;143:171–3.PubMedCrossRef
28.
Murakami T, Nishijima K, Akagi T, Uji A, Horii T, Ueda-Arakawa N, et al. Optical coherence tomographic reflectivity of photoreceptors beneath cystoid spaces in diabetic macular edema. Invest Ophthalmol Vis Sci. 2012;53:1506–11.PubMedCrossRef
29.
Bolz M, Schmidt-Erfurth U, Deak G, Mylonas G, Kriechbaum K, Scholda C. Optical coherence tomographic hyperreflective foci: a morphologic sign of lipid extravasation in diabetic macular edema. Ophthalmology. 2009;116:914–20.PubMedCrossRef
30.
Ota M, Nishijima K, Sakamoto A, Murakami T, Takayama K, Horii T, et al. Optical coherence tomographic evaluation of foveal hard exudates in patients with diabetic maculopathy accompanying macular detachment. Ophthalmology. 2010;117:1996–2002.PubMedCrossRef
31.
Uji A, Murakami T, Nishijima K, Akagi T, Horii T, Arakawa N, et al. Association between hyperreflective foci in the outer retina, status of photoreceptor layer, and visual acuity in diabetic macular edema. Am J Ophthalmol. 2012;153(4):710–717e1.PubMedCrossRef
32.
Murakami T, Nishijima K, Akagi T, Uji A, Horii T, Ueda-Arakawa N, et al. Segmentational analysis of retinal thickness after vitrectomy in diabetic macular edema. Invest Ophthalmol Vis Sci. 2012;53:6668–74.PubMedCrossRef
33.
Murakami T, Nishijima K, Sakamoto A, Ota M, Horii T, Yoshimura N. Foveal cystoid spaces are associated with enlarged foveal avascular zone and microaneurysms in diabetic macular edema. Ophthalmology. 2011;118:359–67.PubMedCrossRef
34.
Sakamoto A, Nishijima K, Kita M, Oh H, Tsujikawa A, Yoshimura N. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2009;247:1325–30.PubMedCrossRef
35.
Maheshwary AS, Oster SF, Yuson RM, Cheng L, Mojana F, Freeman WR. The association between percent disruption of the photoreceptor inner segment-outer segment junction and visual acuity in diabetic macular edema. Am J Ophthalmol. 2010;150(1):63–67e1.PubMedCentralPubMedCrossRef
36.
Forooghian F, Stetson PF, Meyer SA, Chew EY, Wong WT, Cukras C, et al. Relationship between photoreceptor outer segment length and visual acuity in diabetic macular edema. Retina. 2010;30:63–70.PubMedCentralPubMedCrossRef
37.
Otani T, Yamaguchi Y, Kishi S. Correlation between visual acuity and foveal microstructural changes in diabetic macular edema. Retina. 2010;30:774–80.PubMedCrossRef
38.
Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial−diabetic retinopathy vitrectomy study report 2. The diabetic retinopathy vitrectomy study research group. Arch Ophthalmol. 1985;103:1644–52.
39.
La Heij EC, Tecim S, Kessels AG, Liem AT, Japing WJ, Hendrikse F. Clinical variables and their relation to visual outcome after vitrectomy in eyes with diabetic retinal traction detachment. Graefes Arch Clin Exp Ophthalmol. 2004;242:210–7.PubMedCrossRef
40.
Yorston D, Wickham L, Benson S, Bunce C, Sheard R, Charteris D. Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92:365–8.PubMedCrossRef
41.
Petrovic MG, Korosec P, Kosnik M, Hawlina M. Association of preoperative vitreous IL-8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy. Acta Ophthalmol. 2010;88:e311–6.PubMedCrossRef
42.
Rinkoff JS, de Juan E, Jr, McCuen BW. Silicone oil for retinal detachment with advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy. Am J Ophthalmol. 1986;101(2):181–6.PubMedCrossRef
43.
Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial−diabetic retinopathy vitrectomy study report 3. The diabetic retinopathy vitrectomy study research group. Ophthalmology. 1988;95:1307–20.
44.
Byeon SH, Chu YK, Lee H, Lee SY, Kwon OW. Foveal ganglion cell layer damage in ischemic diabetic maculopathy: correlation of optical coherence tomographic and anatomic changes. Ophthalmology. 2009;116(10):1949–1959e8.PubMedCrossRef
45.
Tan O, Chopra V, Lu AT, Schuman JS, Ishikawa H, Wollstein G, et al. Detection of macular ganglion cell loss in glaucoma by Fourier-domain optical coherence tomography. Ophthalmology. 2009;116(12):2305–2314e1–2.PubMedCentralPubMedCrossRef
46.
Lewis H, Abrams GW, Blumenkranz MS, Campo RV. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 1992;99:753–9.PubMedCrossRef
47.
Haller JA, Qin H, Apte RS, Beck RR, Bressler NM, Browning DJ, et al. Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology. 2010;117(6):1087–1093e3.PubMedCrossRef
48.
49.
Simunovic MP, Hunyor AP, Ho IV. Vitrectomy for diabetic macular edema: a systematic review and meta-analysis. Can J Ophthalmol. 2014;49:188–95.PubMedCrossRef
Metadata
Title
Macular morphologic findings on optical coherence tomography after microincision vitrectomy for proliferative diabetic retinopathy
Authors
Tomoaki Murakami
Akihito Uji
Ken Ogino
Noriyuki Unoki
Shin Yoshitake
Yoko Dodo
Takahiro Horii
Kazuaki Nishijima
Nagahisa Yoshimura
Publication date
01-07-2015
Publisher
Springer Japan
Published in
Japanese Journal of Ophthalmology / Issue 4/2015
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-015-0382-4

Other articles of this Issue 4/2015

Japanese Journal of Ophthalmology 4/2015 Go to the issue

Clinical Investigation

Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery

Clinical Investigation

A survey of the surgical treatment of congenital and developmental cataracts in Japan

Clinical Investigation

Increased choroidal blood flow velocity with regression of unilateral acute idiopathic maculopathy

Clinical Investigation

Retinal nerve fiber layer and ganglion cell complex thicknesses measured with spectral-domain optical coherence tomography in eyes with no light perception due to nonglaucomatous optic neuropathy

Clinical Investigation

Effects of corneal irregular astigmatism on visual acuity after conventional and femtosecond laser-assisted Descemet’s stripping automated endothelial keratoplasty

Clinical Investigation

Characteristic correlations of the structure-function relationship in different glaucomatous disc types