TY - JOUR
T1 - Macular hypotrophy after internal limiting membrane removal for diabetic macular edema
AU - Romano, Mario R.
AU - Romano, Vito
AU - Vallejo-Garcia, Jose L.
AU - Vinciguerra, Riccardo
AU - Romano, Mary
AU - Cereda, Matteo
AU - Angi, Martina
AU - Valldeperas, Xavier
AU - Costagliola, Ciro
AU - Vinciguerra, Paolo
PY - 2014
Y1 - 2014
N2 - PURPOSE:: To compare the anatomic and functional effects of three different approaches to nontractional diabetic macular edema. METHODS:: Retrospective comparative study. Sixty eyes of 60 patients diagnosed with cystoid diabetic macular edema and treated with 1.25 mg/mL intravitreal bevacizumab (Group A), laser photocoagulation (Group B), or vitrectomy with inner limiting membrane peeling (Group C) were included in the study. Changes in number of Early Treatment Diabetic Retinopathy Study letters, central macular thickness, largest diameter of the intraretinal cysts (IC), and choroidal thickness were investigated. Analyses were performed during follow-up visits at Months 1, 3, 6, 9, and 12. RESULTS:: Visual acuity only significantly improved in Group A at the last follow-up (P = 0.004). Central macular thickness significantly decreased in every group throughout the follow-up period. Differences in central macular thickness between Groups A and B (P <0.01), A and C (P <0.01), and B and C (P <0.01) were significant. Intraretinal cysts also significantly decreased in each group throughout the follow-up period. Differences in IC size between Groups A and B (P = 0.8), A and C (P = 0.1), and B and C (P = 0.1) were not significant. Choroidal thickness did not undergo any significant change in any group throughout the follow-up period. A significant correlation was also found in Group A between best-corrected visual acuity at month 12 and baseline central macular thickness (R = 0.3; P = 0.006), and in Group B between postoperative best-corrected visual acuity at month 12 and baseline IC size (R = 0.8; P <0.01, negatively correlated at 92.4%). CONCLUSION:: According to our retrospective data, diabetic macular edema with intraretinal cysts larger than 390 μm should not be treated with vitrectomy with ILM peeling, because this may induce subfoveal atrophy, defined as the "Floor Effect," and subsequent visual deterioration.
AB - PURPOSE:: To compare the anatomic and functional effects of three different approaches to nontractional diabetic macular edema. METHODS:: Retrospective comparative study. Sixty eyes of 60 patients diagnosed with cystoid diabetic macular edema and treated with 1.25 mg/mL intravitreal bevacizumab (Group A), laser photocoagulation (Group B), or vitrectomy with inner limiting membrane peeling (Group C) were included in the study. Changes in number of Early Treatment Diabetic Retinopathy Study letters, central macular thickness, largest diameter of the intraretinal cysts (IC), and choroidal thickness were investigated. Analyses were performed during follow-up visits at Months 1, 3, 6, 9, and 12. RESULTS:: Visual acuity only significantly improved in Group A at the last follow-up (P = 0.004). Central macular thickness significantly decreased in every group throughout the follow-up period. Differences in central macular thickness between Groups A and B (P <0.01), A and C (P <0.01), and B and C (P <0.01) were significant. Intraretinal cysts also significantly decreased in each group throughout the follow-up period. Differences in IC size between Groups A and B (P = 0.8), A and C (P = 0.1), and B and C (P = 0.1) were not significant. Choroidal thickness did not undergo any significant change in any group throughout the follow-up period. A significant correlation was also found in Group A between best-corrected visual acuity at month 12 and baseline central macular thickness (R = 0.3; P = 0.006), and in Group B between postoperative best-corrected visual acuity at month 12 and baseline IC size (R = 0.8; P <0.01, negatively correlated at 92.4%). CONCLUSION:: According to our retrospective data, diabetic macular edema with intraretinal cysts larger than 390 μm should not be treated with vitrectomy with ILM peeling, because this may induce subfoveal atrophy, defined as the "Floor Effect," and subsequent visual deterioration.
KW - Choroidal thickness
KW - Diabetic macular edema
KW - Inner limiting membrane peeling
KW - Intraretinal cysts
KW - Intravitreal bevacizumab
KW - Müller cells
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U2 - 10.1097/IAE.0000000000000076
DO - 10.1097/IAE.0000000000000076
M3 - Article
C2 - 24846134
AN - SCOPUS:84901417271
VL - 34
SP - 1182
EP - 1189
JO - Retina
JF - Retina
SN - 0275-004X
IS - 6
ER -