Vitrectomy Outcomes in Eyes with Diabetic Macular Edema and Vitreomacular Traction

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...

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Veröffentlicht in:Ophthalmology (Rochester, Minn.) Minn.), 2010-06, Vol.117 (6), p.1087-1093.e3
Hauptverfasser: Haller, Julia A, Qin, Haijing, Apte, Rajendra S, Beck, Roy R, Bressler, Neil M, Browning, David J, Danis, Ronald P, Glassman, Adam R, Googe, Joseph M, Kollman, Craig, Lauer, Andreas K, Peters, Mark A, Stockman, Margaret E
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container_end_page 1093.e3
container_issue 6
container_start_page 1087
container_title Ophthalmology (Rochester, Minn.)
container_volume 117
creator Haller, Julia A
Qin, Haijing
Apte, Rajendra S
Beck, Roy R
Bressler, Neil M
Browning, David J
Danis, Ronald P
Glassman, Adam R
Googe, Joseph M
Kollman, Craig
Lauer, Andreas K
Peters, Mark A
Stockman, Margaret E
description 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
doi_str_mv 10.1016/j.ophtha.2009.10.040
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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 &gt;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 &lt;250 microns and 68% having at least a 50% reduction in thickening. Visual acuity improved by ≥10 letters in 38% (95% confidence interval, 28%–49%) and deteriorated by ≥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. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.</description><identifier>ISSN: 0161-6420</identifier><identifier>EISSN: 1549-4713</identifier><identifier>DOI: 10.1016/j.ophtha.2009.10.040</identifier><identifier>PMID: 20299105</identifier><identifier>CODEN: OPHTDG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Cohort Studies ; Diabetes. Impaired glucose tolerance ; Diabetic Retinopathy - physiopathology ; Diabetic Retinopathy - surgery ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Eye Diseases - physiopathology ; Eye Diseases - surgery ; Female ; Follow-Up Studies ; Humans ; Macular Edema - physiopathology ; Macular Edema - surgery ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Ophthalmology ; Postoperative Complications ; Prospective Studies ; Retina - pathology ; Retinopathies ; Tomography, Optical Coherence ; Treatment Outcome ; Visual Acuity - physiology ; Vitrectomy ; Vitreous Body - surgery</subject><ispartof>Ophthalmology (Rochester, Minn.), 2010-06, Vol.117 (6), p.1087-1093.e3</ispartof><rights>American Academy of Ophthalmology</rights><rights>2010 American Academy of Ophthalmology</rights><rights>2015 INIST-CNRS</rights><rights>Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c547t-f7873103987f66de70dcd51bca9e0bc42cae165405fa08612626720e23ca42103</citedby><cites>FETCH-LOGICAL-c547t-f7873103987f66de70dcd51bca9e0bc42cae165405fa08612626720e23ca42103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0161642009012809$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=22879937$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20299105$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haller, Julia A</creatorcontrib><creatorcontrib>Qin, Haijing</creatorcontrib><creatorcontrib>Apte, Rajendra S</creatorcontrib><creatorcontrib>Beck, Roy R</creatorcontrib><creatorcontrib>Bressler, Neil M</creatorcontrib><creatorcontrib>Browning, David J</creatorcontrib><creatorcontrib>Danis, Ronald P</creatorcontrib><creatorcontrib>Glassman, Adam R</creatorcontrib><creatorcontrib>Googe, Joseph M</creatorcontrib><creatorcontrib>Kollman, Craig</creatorcontrib><creatorcontrib>Lauer, Andreas K</creatorcontrib><creatorcontrib>Peters, Mark A</creatorcontrib><creatorcontrib>Stockman, Margaret E</creatorcontrib><creatorcontrib>Diabetic Retinopathy Clinical Research Network Writing Committee on behalf of the DRCR.net</creatorcontrib><creatorcontrib>Diabetic Retinopathy Clinical Research Network Writing Committee</creatorcontrib><title>Vitrectomy Outcomes in Eyes with Diabetic Macular Edema and Vitreomacular Traction</title><title>Ophthalmology (Rochester, Minn.)</title><addtitle>Ophthalmology</addtitle><description>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 &gt;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 &lt;250 microns and 68% having at least a 50% reduction in thickening. Visual acuity improved by ≥10 letters in 38% (95% confidence interval, 28%–49%) and deteriorated by ≥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. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic Retinopathy - physiopathology</subject><subject>Diabetic Retinopathy - surgery</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Eye Diseases - physiopathology</subject><subject>Eye Diseases - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Macular Edema - physiopathology</subject><subject>Macular Edema - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Ophthalmology</subject><subject>Postoperative Complications</subject><subject>Prospective Studies</subject><subject>Retina - pathology</subject><subject>Retinopathies</subject><subject>Tomography, Optical Coherence</subject><subject>Treatment Outcome</subject><subject>Visual Acuity - physiology</subject><subject>Vitrectomy</subject><subject>Vitreous Body - surgery</subject><issn>0161-6420</issn><issn>1549-4713</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk1v1DAQtRCIbgv_AKFcEKcs44_Y8QUJleVDKqoEhavldRzWS2Jvbado_30ddmmBC6eRnt97M543CD3DsMSA-avtMuw2eaOXBEAWaAkMHqAFbpismcD0IVoUGq45I3CCTlPaAgDnlD1GJwSIlBiaBfr8zeVoTQ7jvrqcsgmjTZXz1Wpf6k-XN9Vbp9c2O1N90mYadKxWnR11pX1X_dKG8YhfRW2yC_4JetTrIdmnx3qGvr5bXZ1_qC8u3388f3NRm4aJXPeiFRQDla3oOe-sgM50DV4bLS2sDSNGW8wbBk2voeWYcMIFAUuo0YwU4Rl6ffDdTevRdsb6HPWgdtGNOu5V0E79_eLdRn0PN4pIjGkzG7w8GsRwPdmU1eiSscOgvQ1TUoJS3FIBrDDZgWliSCna_q4LBjWnobbqkIaa05jRkkaRPf9zwjvR7_UXwosjQSejhz5qb1y655FWSEnF_Vdt2eeNs1El46w3tnNzeKoL7n-T_GtgBudd6fnDlqS3YYq-ZKWwSkSB-jJfznw4IAGTFiS9BTM5v3o</recordid><startdate>20100601</startdate><enddate>20100601</enddate><creator>Haller, Julia A</creator><creator>Qin, Haijing</creator><creator>Apte, Rajendra S</creator><creator>Beck, Roy R</creator><creator>Bressler, Neil M</creator><creator>Browning, David J</creator><creator>Danis, Ronald P</creator><creator>Glassman, Adam R</creator><creator>Googe, Joseph M</creator><creator>Kollman, Craig</creator><creator>Lauer, Andreas K</creator><creator>Peters, Mark A</creator><creator>Stockman, Margaret E</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20100601</creationdate><title>Vitrectomy Outcomes in Eyes with Diabetic Macular Edema and Vitreomacular Traction</title><author>Haller, Julia A ; Qin, Haijing ; Apte, Rajendra S ; Beck, Roy R ; Bressler, Neil M ; Browning, David J ; Danis, Ronald P ; Glassman, Adam R ; Googe, Joseph M ; Kollman, Craig ; Lauer, Andreas K ; Peters, Mark A ; Stockman, Margaret E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c547t-f7873103987f66de70dcd51bca9e0bc42cae165405fa08612626720e23ca42103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Diabetic Retinopathy - physiopathology</topic><topic>Diabetic Retinopathy - surgery</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Eye Diseases - physiopathology</topic><topic>Eye Diseases - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Macular Edema - physiopathology</topic><topic>Macular Edema - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Ophthalmology</topic><topic>Postoperative Complications</topic><topic>Prospective Studies</topic><topic>Retina - pathology</topic><topic>Retinopathies</topic><topic>Tomography, Optical Coherence</topic><topic>Treatment Outcome</topic><topic>Visual Acuity - physiology</topic><topic>Vitrectomy</topic><topic>Vitreous Body - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haller, Julia A</creatorcontrib><creatorcontrib>Qin, Haijing</creatorcontrib><creatorcontrib>Apte, Rajendra S</creatorcontrib><creatorcontrib>Beck, Roy R</creatorcontrib><creatorcontrib>Bressler, Neil M</creatorcontrib><creatorcontrib>Browning, David J</creatorcontrib><creatorcontrib>Danis, Ronald P</creatorcontrib><creatorcontrib>Glassman, Adam R</creatorcontrib><creatorcontrib>Googe, Joseph M</creatorcontrib><creatorcontrib>Kollman, Craig</creatorcontrib><creatorcontrib>Lauer, Andreas K</creatorcontrib><creatorcontrib>Peters, Mark A</creatorcontrib><creatorcontrib>Stockman, Margaret E</creatorcontrib><creatorcontrib>Diabetic Retinopathy Clinical Research Network Writing Committee on behalf of the DRCR.net</creatorcontrib><creatorcontrib>Diabetic Retinopathy Clinical Research Network Writing Committee</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Ophthalmology (Rochester, Minn.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haller, Julia A</au><au>Qin, Haijing</au><au>Apte, Rajendra S</au><au>Beck, Roy R</au><au>Bressler, Neil M</au><au>Browning, David J</au><au>Danis, Ronald P</au><au>Glassman, Adam R</au><au>Googe, Joseph M</au><au>Kollman, Craig</au><au>Lauer, Andreas K</au><au>Peters, Mark A</au><au>Stockman, Margaret E</au><aucorp>Diabetic Retinopathy Clinical Research Network Writing Committee on behalf of the DRCR.net</aucorp><aucorp>Diabetic Retinopathy Clinical Research Network Writing Committee</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vitrectomy Outcomes in Eyes with Diabetic Macular Edema and Vitreomacular Traction</atitle><jtitle>Ophthalmology (Rochester, Minn.)</jtitle><addtitle>Ophthalmology</addtitle><date>2010-06-01</date><risdate>2010</risdate><volume>117</volume><issue>6</issue><spage>1087</spage><epage>1093.e3</epage><pages>1087-1093.e3</pages><issn>0161-6420</issn><eissn>1549-4713</eissn><coden>OPHTDG</coden><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 &gt;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 &lt;250 microns and 68% having at least a 50% reduction in thickening. Visual acuity improved by ≥10 letters in 38% (95% confidence interval, 28%–49%) and deteriorated by ≥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. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20299105</pmid><doi>10.1016/j.ophtha.2009.10.040</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Biological and medical sciences
Cohort Studies
Diabetes. Impaired glucose tolerance
Diabetic Retinopathy - physiopathology
Diabetic Retinopathy - surgery
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Eye Diseases - physiopathology
Eye Diseases - surgery
Female
Follow-Up Studies
Humans
Macular Edema - physiopathology
Macular Edema - surgery
Male
Medical sciences
Middle Aged
Miscellaneous
Ophthalmology
Postoperative Complications
Prospective Studies
Retina - pathology
Retinopathies
Tomography, Optical Coherence
Treatment Outcome
Visual Acuity - physiology
Vitrectomy
Vitreous Body - surgery
title Vitrectomy Outcomes in Eyes with Diabetic Macular Edema and Vitreomacular Traction
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