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External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy

  • Retinal Disorders
  • Published:
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Abstract

Background

To evaluate the predictors of visual improvement using spectral-domain optical coherence tomography (SD-OCT) in eyes with resistant diabetic macular edema (DME) treated with pars plana vitrectomy.

Methods

Thirty-four eyes with resistant DME were evaluated in a retrospective manner. Several SD-OCT variables including photoreceptor inner segment/outer segment (IS/OS) junction, external limiting membrane (ELM) integrity, and central macular thickness (CMT) before and after the surgery, were evaluated by two experienced observers, masked to visual acuity. The visual improvement was used as the outcome measure for a stepwise regression, while the OCT factors were used as predictors.

Results

The strongest predictor of vision improvement was pre-operative damage to the ELM (p = 0.0277) compared to IS/OS junction (p = 0.03). Pretreatment central macular thickness was a very weak predictor (p = 0.18) of visual improvement. For each percentage increase of ELM integrity there was a 0.13 letter gain in vision. ELM integrity explained 16% of the visual acuity improvement after treatment, which rose to 21% with the addition of CMT. The addition of IS/OS junction in the model did not add predictive information.

Conclusions

Evaluation of ELM preoperatively predicts the vision improvement more accurately than the IS/OS junction and CMT in eyes with DME.

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Acknowledgement

This study was supported by an Unrestricted Research Fund to Jacobs Retina Center at Shiley Eye Center, University of California, San Diego (LC) and NIH EYO 7366 (WRF).

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Author notes

  1. Jae Suk Kim

    Present address: Department of Ophthalmology, Sanggye Paik Hospital, Inje University, Seoul, Korea

Authors and Affiliations

  1. Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, 9415 Campus Point Drive, Rm 217B, La Jolla, CA, 92093, USA

    Jay Kumar Chhablani, Jae Suk Kim, Lingyun Cheng, Igor Kozak & William Freeman

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  1. Jay Kumar Chhablani
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  2. Jae Suk Kim
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  3. Lingyun Cheng
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  4. Igor Kozak
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Corresponding author

Correspondence to William Freeman.

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Authors have full control of all primary data, and we agree to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review their data upon request.

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Chhablani, J.K., Kim, J.S., Cheng, L. et al. External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 250, 1415–1420 (2012). https://doi.org/10.1007/s00417-012-1968-x

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  • DOI: https://doi.org/10.1007/s00417-012-1968-x

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