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Japanese Journal of Ophthalmology
Published in: Japanese Journal of Ophthalmology 5/2015

01-09-2015 | Clinical Investigation

Planned foveal detachment technique for the resolution of diffuse diabetic macular edema

Authors: Yuki Morizane, Shuhei Kimura, Mio Hosokawa, Yusuke Shiode, Masayuki Hirano, Shinichiro Doi, Mika Hosogi, Atsushi Fujiwara, Yasushi Inoue, Fumio Shiraga

Published in: Japanese Journal of Ophthalmology | Issue 5/2015

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Abstract

Purpose

To evaluate the therapeutic efficacy of a novel surgical procedure for diffuse diabetic macular edema (DME), performed in conjunction with conventional vitrectomy.

Methods

This prospective, interventional case series involved 20 eyes of 18 consecutive DME patients with best-corrected visual acuities (BCVAs) between 0.301 and 1.221 logarithm of the minimal angle of resolution (logMAR) units and central retinal thicknesses (CRTs) greater than 275 μm. After vitrectomy, a small retinal detachment was made in the macula by injecting 50–100 μl balanced salt solution into the subretinal space using a 38-gauge needle. Before finishing the surgery, fluid-air exchange was performed. Patients were asked to remain in prone position for 1 day postoperatively. The main outcome measures were CRT and BCVA.

Results

The mean CRT of 554.6 ± 152.7 μm before surgery significantly decreased to 295.6 ± 92.5 μm (p < 0.0001) 1 week after surgery and to 185.8 ± 67.4 μm (p < 0.0001) at 6 months after surgery. The CRT was less than 250 μm in 18 eyes (90 %) at 6 months after surgery. The mean BCVA before surgery (0.706 ± 0.348) significantly improved at 6 months after surgery (0.431 ± 0.392, p < 0.0001). Postoperative BCVAs improved by more than 0.3 logMAR units in 13 eyes (65 %), remained unchanged in six eyes (30 %) and worsened in one eye (5 %). Macular edema recurred in three eyes (15 %) 2 months after surgery.

Conclusions

This novel planned foveal detachment technique facilitated a rapid resolution of DME and contributed to improved visual acuity.
Appendix
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Literature
1.
Photocoagulation for diabetic macular edema. Early treatment diabetic retinopathy study report number 1. Early treatment diabetic retinopathy study research group. Arch Ophthalmol. 1985;103:1796–806.CrossRef
2.
Massin P, Bandello F, Garweg JG, Hansen LL, Harding SP, Larsen M, et al. Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE study): a 12-month, randomized, controlled, double-masked, multicenter phase II study. Diabetes Care. 2010;33:2399–405.CrossRefPubMedCentralPubMed
3.
Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO, et al. The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118:615–25.CrossRefPubMed
4.
Nguyen QD, Shah SM, Khwaja AA, Channa R, Hatef E, Do DV, et al. Two-year outcomes of the ranibizumab for edema of the mAcula in diabetes (READ-2) study. Ophthalmology. 2010;117:2146–51.CrossRefPubMed
5.
Network Diabetic Retinopathy Clinical Research, Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010;117(1064–77):e35.
6.
Brown DM, Nguyen QD, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology. 2013;120:2013–22.CrossRefPubMed
7.
Korobelnik J-F, Do DV, Schmidt-Erfurth U, Boyer DS, Holz FG, Heier JS, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology. 2014;121:2247–54.CrossRefPubMed
8.
Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L, et al. Ranibizumab for diabetic macular edema. Ophthalmology. 2012;119:789–801.CrossRefPubMed
9.
Committee Diabetic Retinopathy Clinical Research Network Writing, 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(1087–1093):e3.
10.
Massin P, Duguid G, Erginay A, Haouchine B, Gaudric A. Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy. Am J Ophthalmol. 2003;135:169–77.CrossRefPubMed
11.
Christoforidis JB, D’Amico DJ. Surgical and other treatments of diabetic macular edema: an update. Int Ophthalmol Clin. 2004;44:139–60.CrossRefPubMed
12.
Wilson CA, Benner JD, Berkowitz BA, Chapman CB, Peshock RM. Transcorneal oxygenation of the preretinal vitreous. Arch Ophthalmol. 1994;112:839–45.CrossRefPubMed
13.
Stefánsson E. The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology. Acta Ophthalmol Scand. 2001;79:435–40.CrossRefPubMed
14.
Stefánsson E. Ocular oxygenation and the treatment of diabetic retinopathy. Surv Ophthalmol. 2006;51:364–80.CrossRefPubMed
15.
Kadonosono K, Itoh N, Ohno S. Perifoveal microcirculation before and after vitrectomy for diabetic cystoid macular edema. Am J Ophthalmol. 2000;130:740–4.CrossRefPubMed
16.
17.
Doi N, Sakamoto T, Sonoda Y, Yasuda M, Yonemoto K, Arimura N, et al. Comparative study of vitrectomy versus intravitreous triamcinolone for diabetic macular edema on randomized paired-eyes. Graefes Arch Clin Exp Ophthalmol. 2011;250:71–8.CrossRefPubMed
18.
Yamamoto T, Hitani K, Tsukahara I, Yamamoto S, Kawasaki R, Yamashita H, et al. Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema. Am J Ophthalmol. 2003;135:14–9.CrossRefPubMed
19.
Stolba U, Binder S, Gruber D, Krebs I, Aggermann T, Neumaier B. Vitrectomy for persistent diffuse diabetic macular edema. Am J Ophthalmol. 2005;140:295.e1–9.CrossRef
20.
Yanyali A, Horozoglu F, Celik E, Nohutcu AF. Long-term outcomes of pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema. Retina. 2007;27:557–66.CrossRefPubMed
21.
Song SJ, Sohn JH, Park KH. Evaluation of the efficacy of vitrectomy for persistent diabetic macular edema and associated factors predicting outcome. Korean J Ophthalmol. 2007;21:146–50.CrossRefPubMedCentralPubMed
22.
Harbour JW, Smiddy WE, Flynn HW, Rubsamen PE. Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol. 1996;121:405–13.CrossRefPubMed
23.
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.CrossRefPubMed
24.
Yanyali A, Bozkurt KT, Macin A, Horozoglu F, Nohutcu AF. Quantitative assessment of photoreceptor layer in eyes with resolved edema after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema. Ophthalmologica. 2011;226:57–63.CrossRefPubMed
25.
Takagi H, Otani A, Kiryu J, Ogura Y. New surgical approach for removing massive foveal hard exudates in diabetic macular edema. Ophthalmology. 1999;106:249–56 (discussion 256–7).CrossRefPubMed
26.
Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999;127:688–93.CrossRefPubMed
27.
Okamoto Y, Okamoto F, Hiraoka T, Oshika T. Vision-related quality of life and visual function following intravitreal bevacizumab injection for persistent diabetic macular edema after vitrectomy. Jpn J Ophthalmol. 2014;58:369–74.CrossRefPubMed
28.
29.
Pieramici DJ, de Juan E, Fujii GY, Reynolds SM, Melia M, Humayun MS, et al. Limited inferior macular translocation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration. Am J Ophthalmol. 2000;130:419–28.CrossRefPubMed
30.
Morizane Y, Shiraga F, Takasu I, Yumiyama S, Okanouchi T, Ohtsuki H. Selection for inferior limited macular translocation on the basis of distance from the fovea to the inferior edge of the subfoveal choroidal neovascularization. Am J Ophthalmol. 2002;133:848–50.CrossRefPubMed
31.
Haupert CL, McCuen BW, Jaffe GJ, Steuer ER, Cox TA, Toth CA, et al. Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration. Am J Ophthalmol. 2001;131:208–15.CrossRefPubMed
32.
Hillenkamp J, Surguch V, Framme C, Gabel V-P, Sachs HG. Management of submacular hemorrhage with intravitreal versus subretinal injection of recombinant tissue plasminogen activator. Graefes Arch Clin Exp Ophthalmol. 2010;248:5–11.CrossRefPubMed
33.
Kimura S, Morizane Y, Hosokawa M, Shiode Y, Kawata T, Doi S. Submacular hemorrhage in polypoidal choroidal vasculopathy treated by vitrectomy and subretinal tissue plasminogen activator. Am J Ophthalmol. 2015;159:683–689.e1.CrossRefPubMed
34.
MacLaren RE, Groppe M, Barnard AR, Cottriall CL, Tolmachova T, Seymour L, et al. Retinal gene therapy in patients with choroideremia: initial findings from a phase 1/2 clinical trial. Lancet. 2014;383:1129–37.CrossRefPubMedCentralPubMed
Metadata
Title
Planned foveal detachment technique for the resolution of diffuse diabetic macular edema
Authors
Yuki Morizane
Shuhei Kimura
Mio Hosokawa
Yusuke Shiode
Masayuki Hirano
Shinichiro Doi
Mika Hosogi
Atsushi Fujiwara
Yasushi Inoue
Fumio Shiraga
Publication date
01-09-2015
Publisher
Springer Japan
Published in
Japanese Journal of Ophthalmology / Issue 5/2015
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-015-0390-4

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