Vitrectomy combined with intraoperative dexamethasone implant for the management of refractory diabetic macular edema

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the 1-year results of vitrectomy performed in combination with intraoperative dexamethasoneimplant for tractional and nontractional refractory diabetic macular edema (DME).
Methods: Thirteen eyes from 13 subjects who were diagnosed with tractional DME and 17 eyes from 17 subjectswho were diagnosed with nontractional refractory DME underwent vitrectomy and dexamethasone implantinjection. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) duringthe one year following vitrectomy were evaluated in each group. Additionally, changes in intraocular pressureand other complications were investigated postoperatively.
Results: In eyes with tractional DME, a statistically significant improvement in BCVA was noted at 3, 6, and 12months, and a statistically significant improvement in CMT was noted at 1, 3, 6, and 12 months from baselineafter vitrectomy (p < 0.05). In eyes with nontractional refractory DME, a statistically significant improvementin BCVA was noted at 12 months, but there were no significant improvements in CMT despite the tendencyto decrease from baseline. Sixteen (53.3%) of the 30 eyes included in this study showed intraocular pressureelevation, which was addressed using antiglaucoma medication, and there were no other severe complications.
Conclusions: Vitrectomy combined with intraoperative dexamethasone implant may be safe and effective intreating DME, especially tractional DME. In this study, patients with nontractional DME required more additionaltreatments and time for anatomical and functional improvement compared to patients with tractionalDME.

참고문헌 (Reference)

1 Bonnin S, "Vitrectomy with internal limiting membrane peeling for tractional and nontractional diabetic macular edema : long-term results of a comparative study" 35 : 921-928, 2015

2 Diabetic Retinopathy Clinical Research Network Writing Committee, "Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction" 117 : 1087-1093, 2010

3 Stolba U, "Vitrectomy for persistent diffuse diabetic macular edema" 140 : 295-301, 2005

4 Pendergast SD, "Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid" 130 : 178-186, 2000

5 Lewis H, "Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction" 99 : 753-759, 1992

6 Harbour JW, "Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane" 121 : 405-413, 1996

7 김재희, "Vitrectomy Combined with Intravitreal Triamcinolone Acetonide Injection and Macular Laser Photocoagulation for Nontractional Diabetic Macular Edema" 대한안과학회 27 (27): 186-193, 2013

8 Kang SW, "Triple therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for intractable diabetic macular edema" 144 : 878-885, 2007

9 Thakur A, "Trabecular meshwork and lens partitioning of corticosteroids : implications for elevated intraocular pressure and cataracts" 129 : 914-920, 2011

10 Boyer DS, "Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema" 121 : 1904-1914, 2014

11 Stefansson E, "The therapeutic effects of retinal laser treatment and vitrectomy : a theory based on oxygen and vascular physiology" 79 : 435-440, 2001

12 Gandorfer A, "Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane" 20 : 126-133, 2000

13 Diabetic Retinopathy Clinical Research Network, "Randomized trial of peribulbar triamcinolone acetonide with and without focal photocoagulation for mild diabetic macular edema : a pilot study" 114 : 1190-1196, 2007

14 Soheilian M, "Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema" 116 : 1142-1150, 2009

15 Arevalo JF, "Primary intravitreal bevacizumab for diffuse diabetic macular edema : the Pan-American Collaborative Retina Study Group at 24 months" 116 : 1488-1497, 2009

16 Nguyen QD, "Primary end point(six months)results of the ranibizumab for edema of the mAcula in diabetes(READ-2)study" 116 : 2175-2181, 2009

17 Entezari M, "Posterior sub-tenon triamcinolone for refractory diabetic macular edema : a randomized clinical trial" 15 : 746-750, 2005

18 "Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group" 103 : 1796-1806, 1985

19 Chang-Lin JE, "Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes" 52 : 4605-4609, 2011

20 Massin P, "Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy" 135 : 169-177, 2003

21 Lee DH, "Minimally invasive microincision vitrectomy surgery with an intraoperative dexamethasone implant for refractory diabetic macular edema" 235 : 150-156, 2016

22 Gillies MC, "Intravitreal triamcinolone for refractory diabetic macular edema : twoyear results of a double-masked, placebo-controlled, randomized clinical trial" 113 : 1533-1538, 2006

23 Massin P, "Intravitreal triamcinolone acetonide for diabetic diffuse macular edema : preliminary results of a prospective controlled trial" 111 : 218-224, 2004

24 Yang Y, "Intravitreal corticosteroids in diabetic macular edema : pharmacokinetic considerations" 35 : 2440-2449, 2015

25 Kiddee W, "Intraocular pressure monitoring post intravitreal steroids : a systematic review" 58 : 291-310, 2013

26 Antonetti DA, "Hydrocortisone decreases retinal endothelial cell water and solute flux coincident with increased content and decreased phosphorylation of occludin" 80 : 667-677, 2002

27 Yau JW, "Global prevalence and major risk factors of diabetic retinopathy" 35 : 556-564, 2012

28 Shah SP, "Factors predicting outcome of vitrectomy for diabetic macular oedema : results of a prospective study" 90 : 33-36, 2006

29 Flaxel CJ, "Factors associated with visual acuity outcomes after vitrectomy for diabetic macular edema : diabetic retinopathy clinical research network" 30 : 1488-1495, 2010

30 Chin HS, "Difference in clearance of intravitreal triamcinolone acetonide between vitrectomized and nonvitrectomized eyes" 25 : 556-560, 2005

31 Medeiros MD, "Dexamethasone intravitreal implant in vitrectomized versus nonvitrectomized eyes for treatment of patients with persistent diabetic macular edema" 30 : 709-716, 2014

32 Haller JA, "Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results" 118 : 2453-2460, 2011

33 Lowder C, "Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis" 129 : 545-553, 2011

34 Kim YT, "Combination of vitrectomy, IVTA, and laser photocoagulation for diabetic macular edema unresponsive to prior treatments; 3-year results" 250 : 679-684, 2012

35 Michaelides M, "A prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema(BOLT study)12-month data : report 2" 117 : 1078-1086, 2010

36 Otani T, "A controlled study of vitrectomy for diabetic macular edema" 134 : 214-219, 2002