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      Macular Tractional Retinoschisis in Proliferative Diabetic Retinopathy: Clinical Characteristics and Surgical Outcome

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          Abstract

          Purpose: To evaluate the clinical characteristics and surgical outcome of macular tractional retinoschisis (TRS) as compared with tractional retinal detachment (TRD) in proliferative diabetic retinopathy (PDR). Methods: This retrospective, longitudinal study collected consecutive cases with optical coherence tomography (OCT)-confirmed TRS and TRD between January 2007 and June 2013. All cases had surgical treatment. Their preoperative findings and follow-up data were subsequently compared. Results: Thirty-two eyes (32 patients) with TRS and 32 eyes (32 patients) with TRD were included. The TRS group had more clinically inactive fibrosis and less extensive fibrovascular proliferation than the TRD group. The involved area and height of the schisis varied among cases; associated macular abnormalities included inner macular cyst (43.75%), lamellar hole (12.5%) and foveal detachment (9.38%); sequential OCT in some cases showed a progression of macular changes. Both groups had significant visual improvement after surgery. Of the patients with TRS, 40.62% had residual retinoschisis. Preoperative best-corrected visual acuity (BCVA), postoperative BCVA and improvement in visual acuity showed no significant difference between TRS and TRD. Conclusions: Unique features exist for macular TRS in PDR. Visual function may benefit from vitreous surgery despite residual macular abnormalities in some cases.

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          A review of clinical trials of anti-VEGF agents for diabetic retinopathy.

          P Nicholson, Andrew Schachat (2010)
          Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population worldwide. Many observational and preclinical studies have implicated vascular endothelial growth factor (VEGF) in the pathogenesis of DR, and recent successes with anti-VEGF therapy for age-related macular degeneration (AMD) have prompted research into the application of anti-VEGF drugs to DR. Here we review the numerous early studies that suggest an important potential role for anti-VEGF agents in the management of diabetic retinopathy. For diabetic macular edema, phase II trials of intravitreal pegaptanib and intravitreal ranibizumab have shown short-term benefit in visual acuity. Intravitreal bevacizumab also has been shown to have beneficial short-term effects on both visual acuity and retinal thickness. For proliferative diabetic retinopathy (PDR), early studies suggest that intravitreal bevacizumab temporarily decreases leakage from diabetic neovascular lesions, but this treatment may be associated with tractional retinal detachment (TRD). Furthermore, several studies indicate that bevacizumab is likely to prove a helpful adjunct to diabetic pars plana vitrectomy (PPV) for TRD. Finally, three small series suggest a potential beneficial effect of a single dose of bevacizumab to prevent worsening of DME after cataract surgery. Use of anti-VEGF medications for any of these indications is off-label. Despite promising early reports on the safety of these medications, we eagerly await the results of large, controlled trials to substantiate the safety and efficacy of anti-VEGF drugs for diabetic retinopathy.
          Article 0 comments Cited 75 times – based on 0 reviews     Review now
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            Foveal microstructure and visual acuity in surgically closed macular holes: spectral-domain optical coherence tomographic analysis.

            Taku Wakabayashi, Maiko Fujiwara, Hirokazu Sakaguchi … (2010)
            To evaluate reconstructive changes in foveal microstructures and identify a correlation with visual outcomes in eyes with surgically closed macular holes (MHs). Retrospective, consecutive, observational case series. Forty eyes (40 patients) with surgically closed MHs. Spectral-domain optical coherence tomography (SD-OCT) was performed to assess the foveal microstructural changes 3 and 12 months postoperatively. The correlation between the postoperative best-corrected visual acuity (BCVA) and the integrity of the foveal photoreceptor layer was evaluated. The integrity of the back-reflection lines from the photoreceptor inner segment (IS) and outer segment (OS) junction and the external limiting membrane (ELM) on SD-OCT images and the BCVA measured on the same day. The integrity of the foveal photoreceptor layer was the only postoperative SD-OCT finding significantly associated with the 3-month BCVA (r=0.483; P=0.002). The eyes were categorized into 3 groups according to restoration of the IS/OS junction and ELM signals: 6 eyes (15%) in group A with complete restoration of the IS/OS junction and the ELM; 26 eyes (65%) in group B with a disrupted IS/OS junction and intact ELM; and 8 eyes (20%) in group C with disruption or loss of the IS/OS junction and the ELM. Although the baseline BCVA did not differ significantly (P=0.137) among groups, the mean 3-month BCVA values in groups A and B, both with reconstructed ELM with or without a restored photoreceptor IS/OS, were significantly better than in group C (P 0.05). Groups A (P=0.029) and B (P<0.001) had significant visual improvement at 12 months; group C did not have marked visual recovery. Fourteen eyes (54%) in group B had subsequent realignment of the foveal photoreceptor IS/OS; no eyes in group C had a restored IS/OS at 12 months. The presence of the ELM at 3 months is a critical structural feature significantly correlated with the BCVA at 12 months (r=0.832, P<0.001). Reconstruction of the foveal ELM in the early postoperative period helps predict subsequent restoration of the foveal photoreceptor layer and the potential for better visual outcomes. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study.

              Timothy D. McHugh, S Sivaprasad, William Jackson … (2012)
              End-stage diabetic eye disease is an important cause of severe visual impairment in the working-age group. With the increasing availability of refined surgical techniques as well as the early diagnosis of disease because of screening, one would predict that the prevalence of this condition is decreasing and the visual outcome is improving. To study the prevalence and visual outcome following vitrectomy for complications of diabetic retinopathy. This study identified the patients who underwent vitrectomy from January 2007 to December 2009 because of diabetes-related complications in South East London. Data collected included baseline demographics, best-corrected visual acuity, indication for the vitrectomy, complication, outcome, and duration of follow-up. The prevalence of people requiring vitrectomy who are registered in the diabetes register of this region was 2 per 1000 people with diabetes. Vitrectomy was required in 185 eyes of 158 patients during this period. These included 83 Caucasians, 51 Afro-Caribbeans, 17 South Asians, and 7 from other ethnic groups. There were 58 patients with type I diabetes and 100 with type II, with a mean duration of diabetes of 23 and 16.5 years, respectively. The reason for vitrectomy included tractional retinal detachment (TRD) in 109 eyes, non-clearing vitreous haemorrhage (NCVH) in 68 eyes, and other causes in 8 eyes. In all, 50% of the eyes with TRD and NCVH, and 87% of the eyes with NCVH improved by at least three ETDRS lines at 12 months. Poor predictors of visual success included longer duration of diabetes (OR: 0.69), use of insulin (OR: 0.04), presence of ischaemic heart disease (OR: 0.04), delay in surgery (OR: 0.59), and the failure to attend clinic appointments (OR: 0.58). Preoperative use of intravitreal bevacizumab in eyes with TRD undergoing vitrectomy showed a marginal beneficial effect on co-existent maculopathy (P=0.08) and required less laser intervention post procedure, but did not affect the number of episodes of late-onset vitreous haemorrhage post vitrectomy (P=0.81). Visual outcome has improved significantly in eyes with complications due to diabetic retinopathy compared with the previously reported Diabetic Vitrectomy Study.
              Article 0 comments Cited 36 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): OPH
                Journal ID (nlm-ta): Ophthalmologica
                Journal ID (doi): 10.1159/issn.0030-3755
                Title: Ophthalmologica
                Publisher: S. Karger AG
                ISSN (Print): 0030-3755
                ISSN (Electronic): 1423-0267
                Publication date Subscription-year: 2014
                Publication date (Print): December 2013
                Publication date (Electronic): 02 October 2013
                Volume: 231
                Issue: 1
                Pages: 23-30
                Affiliations
                aDepartment of Ophthalmology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, and bDepartment of Ophthalmology, National Taiwan University Hospital College of Medicine, National Taiwan University and cNational Taiwan University College of Medicine, Taipei, Taiwan
                Author notes
                *Chung-May Yang, MD, 7 Chung-Shan South Road, Taipei, Taiwan (ROC), E-Mail chungmay@ntu.edu.tw
                Article
                Publisher ID: 355078 Other ID: Ophthalmologica 2014;231:23-30
                DOI: 10.1159/000355078
                PubMed ID: 24107645
                SO-VID: c24871db-c0d9-4874-a569-6925c4372bfa
                Copyright © © 2013 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 05 February 2013
                Date accepted : 19 July 2013
                Page count
                Figures: 6, Tables: 2, Pages: 8
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Diabetes,Macular retinoschisis,Traction
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Diabetes, Macular retinoschisis, Traction

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