Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction.
Diabetic Retinopathy Clinical Research Network Writing Committee,
Haller JA,
Qin H,
Apte RS,
Beck RR,
Bressler NM,
Browning DJ,
Danis RP,
Glassman AR,
Googe JM,
Kollman C,
Lauer AK,
Peters MA,
Stockman ME.
Lauer AK, Wilson DJ, Flaxel CJ, Pope SI, Lundquist AD, Toomey MD, Ira SD, Vahrenwald DR, Nolte SK, Steinkamp PN, Rossi JC, West KL, Pickell SR, Rice PB, Howell CS, Gaultney JM, Wallace PR, Chalam KV, Gupta SK, Grover S, Keshavamurthy R, Singh TM, Syed SN, Brar VS, Carpentier JR, Googe J, Perkins SL, McMillan TA, Higdon CT, Evans S, Morris CD, Johnson MM, Seitz VL, Hunt C, Arnold A, Whetstone JK, Cimino DJ, Blais PA, Jacobus M, Sharuk GS, Sun JK, Murtha TJ, Schlossman DK, Aiello LP, Arrigg PG, Shah ST, Kopple A, Stockman ME, Calderon RM, Weimann ES, Cavallerano JD, Bestourous L, Strong J, Cavicchi RW, Casazza EL, Friedman SM, Plous OZ, Blackmer KA, Key JS, Carlton S, Maldonado J, Fraser-Neumann Y, Gregory V, Sjoblom K, Gostischa K, Walters-Treon S, McKinney A, Apte RS, Engelbrecht NE, Rao PK, Blinder KJ, Nobel GS, Light PA, Weeks RF, Boyd LK, Walters CL, Sgorlon MK, Ressel TJ, Vaughn AM, Wright TL, Gabel DL, Raeber ML, Wehmeier J, Browning D, Antoszyk AN, Brooks DR, Helms JV, Price AK, Cowen MK, Karow AS, Lail W, Murphy HL, Pierce RE, Ennis SA, Walker RO, Powers ME, Ballard JA, Davis LM, George RJ, Balasubramaniam UM, McClain D, McOwen MD, Clark LM, Peters MA, Handelman IL, Hobbs S, Hudson DA, Kramer SM, Kopfer M, Logan J, Daniel H, Hoerner C, Wohlsein H, Lazarus HS, Bunch DP, Ridge AD, Booth K, Davis LC, Trimble M, Moore J, Solomon SD, Finkelstein D, Bressler NM, Frey M, West S, Doll W, Kellner V, Donohue D, Cain D, Shah SM, Emmert D, Falk R, Graul J, McDonald J, Herring C, Faber DW, Mehr DS, Goodart RA, Murphy HJ, Perkins TL, Osguthorpe RW, Knight D, Beer PM, Falk N, Olmeda E, Newton AL, Whitney C, Faulhammer LA, Fischer J, Abraham P, Livermont K, Green BL, Riley K, Stewart D, Robbins E, Frisk TA, Parks D, Edwards PA, Ober MD, Murphy J, Fletcher DQ, Rock SM, Monk MK, Stern BA, Schillace LM, Croswell M, Troszak TA, Ogilvy SF, Smith CW, Woodcome HA, Janigian RH, DuCoty CL, German E, Varadian S, Banalewicz E, Salinas C, Hamel M, Hampton GR, Torrisi PF, Rutledge BK, Grinnell CJ, DiSano FM, Kwasniewski LM, Czajak TC, Hay PB, Capone LA, Corey B, Harrison KM, Gross JG, Fishburne BC, Flowers AM, Cummings PW, Henry KL, Gabriel RA, Lovit HK, Bland KK, Price RL, Mallet CN, Christoff R, Fan JT, Rollins KE, Corliss CJ, Kiernan WH, Cloud JD, Saldana G, Milam W, Patel SS, Flores Y, Garcia KL, Arrington BK, McArthur MD, Bartlett TA, Berger BB, Manhart GJ, Morris R, Nguyen LN, Clevenger-Smith TL, Scrivner EN, Durham EA, Talbert MA, Callen N, Ren Y, Ostrander B, Elman MJ, Sloan MD, Starr J, Singletary PV, Butcher TM, Salfer-Firestone DY, Coffey T, Andreani G, Cain T, Sotirakos P, Shami M, Tarter CL, Pusser P, Squires L, Wentlandt TF, Gonzalez VH, Vann VR, Su YT, McNames RL, Herrera J, Lopez M, Martinez MM, Trevino MG, Herrera A, Garza C, Cuellar D, Corona RM, Klesert TR, Olsen TW, Walski JM, Cook S, Philiph D, Rolfer SM, Patterson PK, Harvey PS, Cohen MJ, Bhavsar A, Emerson GG, Huynh VT, Ries J, Olson TM, Hager CH, Selders DL, Spike ME, Smith CM, Carli WB, Taylor-Reetz L, Kells JA, Chan-Tram C, Benner JD, Butler JW, Scott H, McCrorey JM, Carbaugh C, Hurley RL, Chen M, Niffenegger JH, Wong KL, Holland C, Hagin K, Shelton HR, Miller R, Sneath M, Kinyoun JL, Rath SA, Ernst PK, Leslie JD, Stephens C, Clifton BC, Clark WL, Gridine MD, Cahill CP, McDougal PD, Spivey R, Henderson ML, Hickman AB, Kokame GT, Shen J, Yuen A, Ridley ME, Glessner AE, Schafer ML, Munoz D, Brogdon AA, Cisco JK, Kummer V, Peterson DC, Wang RC, Arnwine J, Sanchez B, Jaramillo D, Aguado H, Cummings K, Aaberg TM, Markus D, Scott S, Kronlein S, Lewis S, Lambert HM, O'Neal MR, Busch SK, Schmidt AW, Morales JA, Maturi RK, Bleau LA, Storie M, Novak CK, Steele T, Poston JL, Maple A, Altaweel MM, Ip MS, Burke KF, Soderling BH, Wealti AM, Somers GF, Krolnik DA, Knutson GE, Peterson JC, Recchia FM, Franklin CC, Kinder KM, Owings S, Taylor-Ward MB, Adkins T, Chan CK, Salib DM, Lin SG, Nuthi AS, Walther KS, Aldana I, Andresen TA, Wiskirchen TB, Warren S, Rollins K, Castillo SU, Chesbrough DJ, Huff KM, Jumper JM, McDonald HR, Stolarczuk M, Fiermonte P, Linares SC, Miller J, Ryan DM, Esquejo RL, Huggans S, Miller DG, McNamara E, Nitzsche TM, Smith-Brewer SK, Stone L, Kaufman SR, Wenz RE, Huff KA, Williams DM, Drouilhet JH, Pelke S, Bell T, Nobler D, Garcia CA, Santisbon E, Villeda PR, Lessieur EM, Nguyen CV, Montoya JP, Stoever CA, Salinas LR, Cerda SM, Kuppermann BD, Grijalva J, Magallon R, Trump B, Cummings HL, Couch DA, Long DJ, Darnell G, Carpenter S, Leonard RE, Youngberg MD, Hart JS, Dwiggins CJ, Burris R, Richmond WR, Baker CW, Caldwell TM, Martin TR, Lambert LF, Darden DD, Travis AB, Roth DB, Tantum TL, Anderson F, Daniels SA, Aguilos MC, Hom N, Combs WM, Teshima-McCormick SM, Hanamoto F, Tolentino M, Hamilton RS, Moon SJ, Anderson JL, Cooper SL, Williams C, Trueman D, Dilts V.
Source
Wills Eye Institute.
Abstract
PURPOSE:
To evaluate vitrectomy for diabetic macular edema (DME) in eyes with at least moderate vision loss and vitreomacular traction.
DESIGN:
Prospective cohort study.
PARTICIPANTS:
The primary cohort included 87 eyes with DME and vitreomacular traction based on investigator's evaluation, visual acuity 20/63-20/400, optical coherence tomography (OCT) central subfield >300 microns and no concomitant cataract extraction at the time of vitrectomy.
METHODS:
Surgery was performed according to the investigator's usual routine. Follow-up visits were performed after 3 months, 6 months (primary end point), and 1 year.
MAIN OUTCOME MEASURES:
Visual acuity, OCT retinal thickening, and operative complications.
RESULTS:
At baseline, median visual acuity in the 87 eyes was 20/100 and median OCT thickness was 491 microns. During vitrectomy, additional procedures included epiretinal membrane peeling in 61%, internal limiting membrane peeling in 54%, panretinal photocoagulation in 40%, and injection of corticosteroids at the close of the procedure in 64%. At 6 months, median OCT central subfield thickness decreased by 160 microns, with 43% having central subfield thickness <250 microns and 68% having at least a 50% reduction in thickening. Visual acuity improved by > or =10 letters in 38% (95% confidence interval, 28%-49%) and deteriorated by > or =10 letters in 22% (95% confidence interval, 13%-31%). Postoperative complications through 6 months included vitreous hemorrhage (5 eyes), elevated intraocular pressure requiring treatment (7 eyes), retinal detachment (3 eyes), and endophthalmitis (1 eye). Few changes in results were noted between 6 months and 1 year.
CONCLUSIONS:
After vitrectomy performed for DME and vitreomacular traction, retinal thickening was reduced in most eyes. Between 28% and 49% of eyes with characteristics similar to those included in this study are likely to have improvement of visual acuity, whereas between 13% and 31% are likely to have worsening. The operative complication rate is low and similar to what has been reported for this procedure. These data provide estimates of surgical outcomes and serve as a reference for future studies that might consider vitrectomy for DME in eyes with at least moderate vision loss and vitreomacular traction.
Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
- PMID:
- 20299105
- [PubMed - indexed for MEDLINE]
- PMCID: PMC2911350
Free PMC ArticleFigure 1
Distribution of Change in Visual Acuity from Baseline
Ophthalmology. Ophthalmology;117(6):1087-1093.e3.
Figure 2
Distribution of Change in optical coherence tomography (OCT) Central Subfield Thickness in Categories According to Baseline Thickness
Box-whisker plot demonstrating mean (dashed horizontal line), median (solid horizontal line), 25 – 75th percentiles (extremes of the box), 10–90th percentiles (whiskers) and 5–95th percentiles (solid circles) of change in optical coherence tomography (OCT) central subfield.
Ophthalmology. Ophthalmology;117(6):1087-1093.e3.
Figure 3
Comparison of Change in Optical Coherence Tomography (OCT) Central Subfield and Change in Visual Acuity from Baseline to 6 Months. The solid line represents the regression line and the dotted lines represent the 95% confidence interval for the mean.
Ophthalmology. Ophthalmology;117(6):1087-1093.e3.
Publication Types
MeSH Terms
Grant Support
Full Text Sources
Other Literature Sources
Medical