Japanese Journal of Ophthalmology

, Volume 59, Issue 4, pp 236–243 | Cite as

Macular morphologic findings on optical coherence tomography after microincision vitrectomy for proliferative diabetic retinopathy

  • Tomoaki Murakami
  • Akihito Uji
  • Ken Ogino
  • Noriyuki Unoki
  • Shin Yoshitake
  • Yoko Dodo
  • Takahiro Horii
  • Kazuaki Nishijima
  • Nagahisa Yoshimura
Clinical Investigation
First Online:
Received:
Accepted:

Abstract

Purpose

To investigate macular morphology on spectral-domain optical coherence tomography (SD-OCT) images after microincision vitrectomy for vitreous hemorrhage associated with proliferative diabetic retinopathy (PDR).

Methods

In this retrospective case series, 69 eyes (57 consecutive patients) that underwent 23-gauge microincision vitrectomy for vitreous hemorrhage due to PDR were investigated. Qualitative and quantitative characteristics on SD-OCT images [central retinal thickness, external limiting membrane (ELM), and the ellipsoid zone, epiretinal membranes involving the fovea, and hyperreflective foci at the fovea] were assessed 6 months postoperatively. Their association with the logarithm of the minimum angle of resolution visual acuity (logMAR VA) was evaluated.

Results

The ELM was disrupted in 15 and the ellipsoid zone in 27 eyes, and associated significantly (P < 0.001, for both comparisons) with poor visual outcomes 6 months postoperatively. Hyperreflective foci in the outer retinal layers were associated with either a disrupted ELM or ellipsoid zone and poor prognoses (P < 0.001, for all comparisons). The accumulation of hyperreflective foci at the fovea in five eyes was correlated significantly (P < 0.001) with poorer logMAR VA. Twenty-nine eyes had center-involved diabetic macular edema 6 months postoperatively, whereas the central thickness was not correlated with the logMAR VA (R = −0.148, P = 0.224). Eight eyes with either epiretinal membrane on SD-OCT images had greater central thickness (P = 0.003), although there were no differences in the logMAR VA between eyes with and without it (P = 0.648).

Conclusions

Foveal photoreceptor damage is associated with poor visual outcomes after microincision vitrectomy for vitreous hemorrhage due to PDR.

Keywords

Hyperreflective foci Microincision vitrectomy surgery Optical coherence tomography Photoreceptor Proliferative diabetic retinopathy 
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Notes

Conflicts of interest

T. Murakami, None; A. Uji, None; K. Ogino, None; N. Unoki, None; S. Yoshitake, None, Y. Dodo, None; T. Horii, None, K. Nishijima, None; N. Yoshimura; None.

References

  1. 1.
    Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984;102:527–32.PubMedCrossRefGoogle Scholar
  2. 2.
    Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35:556–64.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994;331:1480–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Adamis AP, Miller JW, Bernal MT, D’Amico DJ, Folkman J, Yeo TK, et al. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy. Am J Ophthalmol. 1994;118:445–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Preliminary report on effects of photocoagulation therapy. The Diabetic Retinopathy Study Research Group. Am J Ophthalmol. 1976;81:383–96.Google Scholar
  6. 6.
    Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med. 2012;366:1227–39.PubMedCrossRefGoogle Scholar
  7. 7.
    Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA. 2007;298:902–16.PubMedCrossRefGoogle Scholar
  8. 8.
    Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study (DRVS) report #1. Ophthalmology. 1985;92:492–502.Google Scholar
  9. 9.
    Ho T, Smiddy WE, Flynn HW Jr. Vitrectomy in the management of diabetic eye disease. Surv Ophthalmol. 1992;37:190–202.PubMedCrossRefGoogle Scholar
  10. 10.
    Gandorfer A, Kampik A. Pars plana vitrectomy in diabetic retinopathy. From pathogenetic principle to surgical strategy. Ophthalmologe. 2000;97:325–30 (in German).PubMedCrossRefGoogle Scholar
  11. 11.
    Helbig H, Sutter FK. Surgical treatment of diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2004;242:704–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Ahn J, Woo SJ, Chung H, Park KH. The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy. Ophthalmology. 2011;118:2218–26.PubMedCrossRefGoogle Scholar
  13. 13.
    Zhao LQ, Zhu H, Zhao PQ, Hu YQ. A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy. Br J Ophthalmol. 2011;95:1216–22.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Helbig H, Kellner U, Bornfeld N, Foerster MH. Rubeosis iridis after vitrectomy for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 1998;236:730–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Novak MA, Rice TA, Michels RG, Auer C. Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology. 1984;91:1485–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Tardif YM, Schepens CL. Closed vitreous surgery: XV. Fibrovascular ingrowth from the pars plana sclerotomy. Arch Ophthalmol. 1977;95:235–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Fujii GY, De Juan E, Jr, Humayun, Pieramici DJ, Chang TS, Awh C, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109(10):1807–12 (discussion 13).PubMedCrossRefGoogle Scholar
  18. 18.
    Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005;25:208–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Shimada H, Nakashizuka H, Mori R, Mizutani Y. Expanded indications for 25-gauge transconjunctival vitrectomy. Jpn J Ophthalmol. 2005;49:397–401.PubMedCrossRefGoogle Scholar
  20. 20.
    Gosse E, Newsom R, Lochhead J. The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy. Eye (Lond). 2012;26:140–3.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Cha DM, Woo SJ, Park KH, Chung H. Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2013;251(6):1469–74.PubMedCrossRefGoogle Scholar
  22. 22.
    Hee MR, Puliafito CA, Duker JS, Reichel E, Coker JG, Wilkins JR, et al. Topography of diabetic macular edema with optical coherence tomography. Ophthalmology. 1998;105:360–70.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999;127:688–93.PubMedCrossRefGoogle Scholar
  24. 24.
    Murakami T, Nishijima K, Sakamoto A, Ota M, Horii T, Yoshimura N. Association of pathomorphology, photoreceptor status, and retinal thickness with visual acuity in diabetic retinopathy. Am J Ophthalmol. 2011;151:310–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Browning DJ, Glassman AR, Aiello LP, Beck RW, Brown DM, Fong DS, et al. Relationship between optical coherence tomography–measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology. 2007;114:525–36.PubMedCrossRefGoogle Scholar
  26. 26.
    Spaide RF, Curcio CA. Anatomical correlates to the bands seen in the outer retina by optical coherence tomography: literature review and model. Retina. 2011;31:1609–19.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Murakami T, Tsujikawa A, Ohta M, Miyamoto K, Kita M, Watanabe D, et al. Photoreceptor status after resolved macular edema in branch retinal vein occlusion treated with tissue plasminogen activator. Am J Ophthalmol. 2007;143:171–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Murakami T, Nishijima K, Akagi T, Uji A, Horii T, Ueda-Arakawa N, et al. Optical coherence tomographic reflectivity of photoreceptors beneath cystoid spaces in diabetic macular edema. Invest Ophthalmol Vis Sci. 2012;53:1506–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Bolz M, Schmidt-Erfurth U, Deak G, Mylonas G, Kriechbaum K, Scholda C. Optical coherence tomographic hyperreflective foci: a morphologic sign of lipid extravasation in diabetic macular edema. Ophthalmology. 2009;116:914–20.PubMedCrossRefGoogle Scholar
  30. 30.
    Ota M, Nishijima K, Sakamoto A, Murakami T, Takayama K, Horii T, et al. Optical coherence tomographic evaluation of foveal hard exudates in patients with diabetic maculopathy accompanying macular detachment. Ophthalmology. 2010;117:1996–2002.PubMedCrossRefGoogle Scholar
  31. 31.
    Uji A, Murakami T, Nishijima K, Akagi T, Horii T, Arakawa N, et al. Association between hyperreflective foci in the outer retina, status of photoreceptor layer, and visual acuity in diabetic macular edema. Am J Ophthalmol. 2012;153(4):710–717e1.PubMedCrossRefGoogle Scholar
  32. 32.
    Murakami T, Nishijima K, Akagi T, Uji A, Horii T, Ueda-Arakawa N, et al. Segmentational analysis of retinal thickness after vitrectomy in diabetic macular edema. Invest Ophthalmol Vis Sci. 2012;53:6668–74.PubMedCrossRefGoogle Scholar
  33. 33.
    Murakami T, Nishijima K, Sakamoto A, Ota M, Horii T, Yoshimura N. Foveal cystoid spaces are associated with enlarged foveal avascular zone and microaneurysms in diabetic macular edema. Ophthalmology. 2011;118:359–67.PubMedCrossRefGoogle Scholar
  34. 34.
    Sakamoto A, Nishijima K, Kita M, Oh H, Tsujikawa A, Yoshimura N. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2009;247:1325–30.PubMedCrossRefGoogle Scholar
  35. 35.
    Maheshwary AS, Oster SF, Yuson RM, Cheng L, Mojana F, Freeman WR. The association between percent disruption of the photoreceptor inner segment-outer segment junction and visual acuity in diabetic macular edema. Am J Ophthalmol. 2010;150(1):63–67e1.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Forooghian F, Stetson PF, Meyer SA, Chew EY, Wong WT, Cukras C, et al. Relationship between photoreceptor outer segment length and visual acuity in diabetic macular edema. Retina. 2010;30:63–70.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Otani T, Yamaguchi Y, Kishi S. Correlation between visual acuity and foveal microstructural changes in diabetic macular edema. Retina. 2010;30:774–80.PubMedCrossRefGoogle Scholar
  38. 38.
    Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial−diabetic retinopathy vitrectomy study report 2. The diabetic retinopathy vitrectomy study research group. Arch Ophthalmol. 1985;103:1644–52.Google Scholar
  39. 39.
    La Heij EC, Tecim S, Kessels AG, Liem AT, Japing WJ, Hendrikse F. Clinical variables and their relation to visual outcome after vitrectomy in eyes with diabetic retinal traction detachment. Graefes Arch Clin Exp Ophthalmol. 2004;242:210–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Yorston D, Wickham L, Benson S, Bunce C, Sheard R, Charteris D. Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92:365–8.PubMedCrossRefGoogle Scholar
  41. 41.
    Petrovic MG, Korosec P, Kosnik M, Hawlina M. Association of preoperative vitreous IL-8 and VEGF levels with visual acuity after vitrectomy in proliferative diabetic retinopathy. Acta Ophthalmol. 2010;88:e311–6.PubMedCrossRefGoogle Scholar
  42. 42.
    Rinkoff JS, de Juan E, Jr, McCuen BW. Silicone oil for retinal detachment with advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy. Am J Ophthalmol. 1986;101(2):181–6.PubMedCrossRefGoogle Scholar
  43. 43.
    Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial−diabetic retinopathy vitrectomy study report 3. The diabetic retinopathy vitrectomy study research group. Ophthalmology. 1988;95:1307–20.Google Scholar
  44. 44.
    Byeon SH, Chu YK, Lee H, Lee SY, Kwon OW. Foveal ganglion cell layer damage in ischemic diabetic maculopathy: correlation of optical coherence tomographic and anatomic changes. Ophthalmology. 2009;116(10):1949–1959e8.PubMedCrossRefGoogle Scholar
  45. 45.
    Tan O, Chopra V, Lu AT, Schuman JS, Ishikawa H, Wollstein G, et al. Detection of macular ganglion cell loss in glaucoma by Fourier-domain optical coherence tomography. Ophthalmology. 2009;116(12):2305–2314e1–2.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Lewis H, Abrams GW, Blumenkranz MS, Campo RV. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 1992;99:753–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Haller JA, Qin H, Apte RS, Beck RR, Bressler NM, Browning DJ, et al. Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology. 2010;117(6):1087–1093e3.PubMedCrossRefGoogle Scholar
  48. 48.
    Charles S. Illumination and phototoxicity issues in vitreoretinal surgery. Retina. 2008;28:1–4.PubMedCrossRefGoogle Scholar
  49. 49.
    Simunovic MP, Hunyor AP, Ho IV. Vitrectomy for diabetic macular edema: a systematic review and meta-analysis. Can J Ophthalmol. 2014;49:188–95.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2015

Authors and Affiliations

  • Tomoaki Murakami
    • 1
  • Akihito Uji
    • 1
  • Ken Ogino
    • 1
  • Noriyuki Unoki
    • 1
  • Shin Yoshitake
    • 1
  • Yoko Dodo
    • 1
  • Takahiro Horii
    • 1
  • Kazuaki Nishijima
    • 1
  • Nagahisa Yoshimura
    • 1
  1. 1.Department of Ophthalmology and Visual SciencesKyoto University Graduate School of MedicineKyotoJapan

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