Abstract
Purpose
To evaluate the long-term effects of combined therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation on diabetic macular edema (DME) unresponsive to prior treatment.
Methods
Medical records of 46 eyes of 41 subjects who underwent sequential combined therapy consisting of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for refractory DME of non-tractional origin were reviewed. Best-corrected visual acuity (BCVA), central subfield thickness (CST) of macula, and number of additional treatments were analyzed.
Results
Forty eyes of 35 patients completed a 3-year follow-up. The mean (± SD) CSTs before and 6 months, 1 year, 2 years, and 3 years after the administration of combined therapy in these eyes were 499.1 ± 174.9, 224.2 ± 110.2, 273.4 ± 173.5, 237.5 ± 84.2 and 219.4 ± 66.6 µm, respectively (p < 0.001). The mean (± SD) logMAR BCVA before and 6 months, 1 year, 2 years, and 3 years after the combined therapy were 0.82 ± 0.32, 0.69 ± 0.40, 0.63 ± 0.39, 0.61 ± 0.46, and 0.55 ± 0.44, respectively (p < 0.001). Thirty-one of 40 eyes (77.5%) exhibited no recurrence of DME after the combined therapy. No visually significant complications other than progression of lens opacity and elevation of intraocular pressure were noted during the study period.
Conclusions
This study demonstrated the long-term stability and efficacy of the combined therapy described herein for the treatment of refractory DME.
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References
Early Treatment Diabetic Retinopathy Study research group (1985) Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol 103:1796–1806
Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, Hartnett E, Ip MS, Kim JE, Kollman C (2009) Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol 127:245–251
Gandorfer A, Messmer EM, Ulbig MW, Kampik A (2000) Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina 20:126–133
Stefansson E (2001) The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology. Acta Ophthalmol Scand 79:435–440
Lee SS, Ghosn C, Yu Z, Zacharias LC, Kao H, Lanni C, Abdelfattah N, Kuppermann B, Csaky KG, D’Argenio DZ, Burke JA, Hughes PM, Robinson MR (2010) Vitreous VEGF clearance is increased after vitrectomy. Invest Ophthalmol Vis Sci 51:2135–2138
Kumagai K, Furukawa M, Ogino N, Larson E, Iwaki M, Tachi N (2009) Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema. Retina 29:464–472
Yanyali A, Horozoglu F, Celik E, Ercalik Y, Nohutcu AF (2006) Pars plana vitrectomy and removal of the internal limiting membrane in diabetic macular edema unresponsive to grid laser photocoagulation. Eur J Ophthalmol 16:573–581
Patel JI, Hykin PG, Schadt M, Luong V, Fitzke F, Gregor ZJ (2006) Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina 26:5–13
Dillinger P, Mester U (2004) Vitrectomy with removal of the internal limiting membrane in chronic diabetic macular oedema. Graefes Arch Clin Exp Ophthalmol 242:630–637
Rosenblatt BJ, Shah GK, Sharma S, Bakal J (2005) Pars plana vitrectomy with internal limiting membranectomy for intractable diabetic macular edema without a taut posterior hyaloid. Graefes Arch Clin Exp Ophthalmol 243:20–25
Recchia FM, Ruby AJ, Carvalho Recchia CA (2005) Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema. Am J Ophthalmol 139:447–454
Kang SW, Park SC, Cho HY, Kang JH (2007) Triple therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for intractable diabetic macular edema. Am J Ophthalmol 144:878–885
Yamamoto T, Akabane N, Takeuchi S (2001) Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol 132:369–377
Yamamoto T, Hitani K, Tsukahara I, Yamamoto S, Kawasaki R, Yamashita H, Takeuchi S (2003) Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema. Am J Ophthalmol 135:14–19
Yanyali A, Horozoglu F, Celik E, Nohutcu AF (2007) Long-term outcomes of pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema. Retina 27:557–566
Estabrook EJ, Madhusudhana KC, Hannan SR, Newsom RS (2007) Can optical coherence tomography predict the outcome of laser photocoagulation for diabetic macular edema? Ophthalmic Surg Lasers Imaging 38:478–483
Itaya M, Sakurai E, Nozaki M, Yamada K, Yamasaki S, Asai K, Ogura Y (2007) Upregulation of VEGF in murine retina via monocyte recruitment after retinal scatter laser photocoagulation. Invest Ophthalmol Vis Sci 48:5677–5683
Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, Pasquale LR, Thieme H, Iwamoto MA, Park JE, Nguyen HV, Aiello LM, Ferrara N, King GL (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487
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The authors have no financial interest in any aspect of this article.
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This work was supported by the Ewha Womans University Research Grant of 2011
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This work was supported by the Ewha Womans University Research Grant of 2011.
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Kim, Y.T., Kang, S.W., Kim, S.J. et al. Combination of vitrectomy, IVTA, and laser photocoagulation for diabetic macular edema unresponsive to prior treatments; 3-year results. Graefes Arch Clin Exp Ophthalmol 250, 679–684 (2012). https://doi.org/10.1007/s00417-011-1888-1
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DOI: https://doi.org/10.1007/s00417-011-1888-1