Naoko Tachi

Vitrectomy for diffuse macular edema in cases of diabetic retinopathy

PURPOSE To ascertain the effects of posterior vitreous detachment for diffuse diabetic macular edema. METHODS We performed vitrectomy on 58 eyes of 41 consecutive patients with diabetic macular edema without posterior vitreous detachment. Follow-up was done at 12 months postoperatively. RESULTS In 57 of 58 eyes after vitrectomy and posterior vitreous detachment, macular edema resolved, and diffuse fluorescein leakage disappeared in 35 of 36 eyes examined at the 12th month. Visual improvement was statistically significant (P < .0001, paired t test). CONCLUSION In eyes with diffuse diabetic macular edema and without posterior vitreous detachment, vitrectomy with posterior vitreous detachment may be effective.

Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema.

Purpose: To report the long-term results of pars plana vitrectomy for diffuse nontractional diabetic macular edema. Design: Interventional, retrospective, consecutive case series. Methods: Clinical records of 332 consecutive patients (496 eyes) with diabetic macular edema without a thickened and taut posterior hyaloid on contact lens examination were reviewed. Four hundred eighty-six eyes of 326 consecutive patients were included in this study. All patients underwent pars plana vitrectomy with the creation of a posterior vitreous detachment by one surgeon. Simultaneous phacoemulsification with intraocular lens implantation was performed on 456 phakic eyes. Internal limiting membrane peeling was performed on 178 (36.6%) of 486 eyes. The main outcome measured was best-corrected visual acuity results during follow-up periods. Results: Postoperative follow-up ranged from 12 to 170 months (mean, 74.0 months). Five year follow-up data were available for 356 (71.8%) of 496 eyes. Mean preoperative best-corrected visual acuity significantly increased from 0.19 (20/105) to 0.32 (20/63) at 1 year after surgery (P < 0.0001), and 0.30 (20/67) at the final visit (P < 0.0001). The final best-corrected visual acuity improved in 256 (52.7%) of the 486 eyes, remained unchanged in 152 eyes (31.3%), and worsened in 78 eyes (16.0%). Postoperative major complications included neovascular glaucoma in 19 eyes (3.9%), recurrent vitreous hemorrhage in 10 eyes (2.1%), hard exudate deposits in the center of the macula in 21 eyes (4.2%), and glaucoma in 22 eyes (4.5%). Conclusions: Pars plana vitrectomy with and without internal limiting membrane peeling appears to be beneficial in eyes with diffuse nontractional diabetic macular edema, and its effectiveness is maintained long term.

Internal Limiting Membrane Peeling in Vitreous Surgery for Diabetic Macular Edema

PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling in vitreous surgery for diabetic macular edema. METHODS: This study was done on 135 eyes of 103 patients who all underwent diabetic macular edema surgery under the same surgeon. The subjects were 74 eyes of 55 males and 61 eyes of 48 females, aged 35-81 years, with an average of 62 years. The postoperative follow-up period ranged from 12 to 39 months, with an average of 20 months. The ILM peeling was performed in 74 eyes. The subjects were divided in two types of macular edema from the presence (type II, 81 eyes) or absence (type I, 54 eyes) of hard exudates in the macular region. We evaluated the effects of the ILM peeling on the absorption rate of macular edema, the period required for absorption of macular edema, and the postoperative visual acuity. RESULTS: The absorption rate of macular edema was more than 90% with or without the ILM peeling. The period required for absorption of macular edema in eyes with ILM peeling was shorter in type II. There was no difference in the postoperative visual acuity with or without ILM peeling. ILM peeling was not an important factor for the postoperative visual acuity. RESULTS: ILM peeling accelerates the absorption of edema in more severe diabetic macular edema, but we could not find any improvement of visual acuity.

Incidence of Reopening and Variables That Influence Reopening After Macular Hole Surgery

PURPOSE To evaluate the incidence and variables of reopening of macular holes after macular hole surgery. METHODS Our study included 467 eyes in which maculor holes were successfully closed after surgery. Surgical techniques consisted of conventional methods (358 eyes) and scalping methods (109 eyes) with retinal pigment scalping of the macular hole basis added in such cases: reoperation, hole size (more than 0.4 disc diameter), duration of symptoms (more than 2 years). Long term incidence of reopening was predicted by life table method. After we compared reopened cases with non-reopened cases, the variables of gender, stage, biocular occurrence, age, duration of symptoms, hole size, preoperative visual acuity, refraction axial length ratio, and intraoperative retinal tears were used for the multiple regression. RESULTS Reopening was found in 20 eyes (5.6%) treated by conventional methods and in 10 eyes (9.2%) treated by scalping methods. Survival ratio was 87% for the conventional methods in 6 years and 79% for the scalping methods in 5 years. The variables influencing reopening were as follows: conventional methods: gender (r = 0.065, p = 0.19), biocular occurrence (r = 0.12, p = 0.026), and refraction axial length ratio (r = -0.11, p = 0.045); scalping methods: hole size (r = 0.14, p = 0.25). CONCLUSIONS Incidence of reopening in scalping methods was high. The variables that influenced reopening after macular hole surgery were biocular occurrence and refraction axial length ratio in conventional methods. The shape of the eye may be related to reopening.

Clinical Features of Idiopathic Macular Holes

PURPOSE The purpose of this study was to evaluate the clinical features of idiopathic macular holes. MATERIALS AND METHODS The clinical features were examined in consequentive 526 eyes of 480 patients with idiopathic macular hole who underwent vitrectomy. RESULTS Sixty-seven% of the patients were female. The mean onset age was 64.4 years of age and 60% of the cases were in their 60s at the time of onset. The mean refractive value was -0.66 dioptor and 40% of the cases were emmetropia with a refractive value between -1.0 dioptor and +1.0 dioptor. The onset age was positively correlated with refractive value. The visual acuity was negatively correlated with onset age, duration after onset, and the size of the macular hole. The duration was positively correlated with onset age. The size of the macular hole was positively correlated with age and duration. The factors for good visual acuity were determined by bilaterality, youth, or small size. Also we found the factors for large size of macular holes to be female gender, long duration of the hole, being in stage 4, and low visual acuity. CONCLUSIONS The incidence of idiopathic macular hole is seen more in eyes of patients in their 60s and in emmetropic eyes. Patients with myopic eyes tend to have younger onset. The size of the macular hole in females tends to be larger than in males.

Variables that influence visual acuity after macular hole surgery

Purpose: To evaluate the variables that influence visual acuity and visual improvement after macular hole surgery.Methods: Our study included 421 eyes in which macular holes were successfully closed after surgery and followed up at least 1 year after the last surgery. Surgical techniques were conventional methods (Group 1: 350 eyes) with retinal pigment scalping of the macular hole basis added in the refractory cases (Group 2: 71 eyes). The variables used for the multiple regression were gender, age, preoperative visual acuity, hole stage, duration of symptoms, hole size, and axial length.Results: The variables that most influenced postoperative visual acuity were as follows: Group 1: gender (r = -0.011, P =.016), age (r = -0.17, P =.005), preoperative visual acuity (r = 0.51, P <.0001), duration of symptoms (r = -0.015, P <.0001), and axial length (r = -0.090, P =.045). Group 2: age (r = -0.18, P =.047), and preoperative visual acuity (r = 0.47, P <.0001).Conclusions: The variables that influenced visual acuity and visual improvement after macular hole surgery were common. In Group 1: gender, age, preoperative visual acuity, duration of symptoms, and axial length; in Group 2: age and preoperative visual acuity.

Factors related to initial success in macular hole surgery

PURPOSE To evaluate the factors of initial success in macular hole surgery. METHODS This study included 526 eyes of 480 patients who underwent idiopathic macular hole surgery by one and the same surgeon. Surgical methods included conventional method (392 eyes), retinal pigment epithelium (RPE) scalping (61 eyes), internal limiting membrane (ILM) removal (62 eyes), and RPE scalping combined with ILM removal (11 eyes). To evaluate the factors of initial success multiple regression was performed using the variables of (gender, age, stage, duration of symptoms, hole size, axial length, and preoperative visual acuity). RESULTS The rate of initial success was 81.4% in all eyes, 80.9% in the conventional method, 78.7% in RPE scalping, 83.9% in ILM removal, and 100% in RPE scalping combined with ILM removal. Significant factors of initial success were as follows: gender (r = -0.091, p = 0.053), age (r = -0.14, p = 0.0062), duration of symptoms (r = -0.23, p < 0.0001), hole size (r = -0.23, p < 0.0001), and axial length (r = -0.21, p < 0.0001) in the conventional method, hole size (r = -0.56, p = 0.0006) in ILM removal and stage (r = -0.43, p = 0.0011) and preoperative visual acuity (r = 0.30, p = 0.018) in RPE scalping. CONCLUSIONS Significant factors of initial success were being male being young, shorter duration of symptoms, smaller hole size, and shorter axial length in the conventional method, smaller hole size in ILM removal and stage 4 and better preoperative visual acuity in RPE scalping method.

Descemet's stripping and non-Descemet's stripping automated endothelial keratoplasty for microcornea using 6.0 mm donor grafts.

Background The purpose of this paper is to report our experience of Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty (DSAEK/nDSAEK) for microcorneas using 6.0 mm donor grafts. Methods Three eyes of two patients (a 56-year-old woman and a 59-year-old woman) with microcornea and suffering from bullous keratopathy were treated with either DSAEK or nDSAEK. A small donor graft (6.0 mm) was inserted into the anterior chamber using a double glide (Busin glide and intraocular lens sheet glide) donor insertion technique. Both patients were followed for at least 12 months. Clinical outcomes, including intraoperative and postoperative complications, visual acuity, and endothelial cell density were evaluated. Results In all three cases (100%), no intraoperative complications were noted. In one case with a flat keratometry value (32.13 D), a partial donor detachment was noted one day postoperatively, but it was reattached by rebubbling. In another case, rejection was noted 8 months postoperatively, but treatment with systemic corticosteroids was successful. A clear cornea remained in all three cases (100%), with best-corrected visual acuity greater than 20/100 (mean 20/50) at 12 months. Mean postoperative endothelial cell counts were 2,603 ± 18 cells/mm2 at 6 months (7.4% decrease from preoperative donor cell counts) and 1,799 ± 556 cells/mm2 at 12 months (36.5% decrease). Conclusion We report for the first time the successful use of a small donor graft (6.0 mm) for DSAEK/nDSAEK in cases of microcornea. Additional stud ies using a large number of patients are required to evaluate fully the potential advantages and drawbacks of small diameter donor grafts for microcornea.

Subretinal Washout for Subtle Subfoveal Hard Exudates in Diabetic Macular Edema

PurposeTo evaluate the efficacy of subretinal washout for subtle subfoveal hard exudates in diabetic macular edema.MethodsThis study was done retrospectively on a series of patients with diffuse diabetic macular edema accompanied with subtle subfoveal hard exudates and operated on by one surgeon (NO). Patients ranged in age from 30 to 76 years (mean, 59 years). The postoperative follow-up interval ranged from 12 to 76 months, with a mean of 35 months. Two groups were identified. The first group contained all 26 eyes that had vitreous surgery with subretinal washout. This was compared with a second group of 51 eyes without subretinal washout. We compared the rate of occurrence of postoperative massive foveal hard exudates, visual acuity results, and complications with and without subretinal washout.ResultThere was no significant difference in base line demographics between the two groups. Massive foveal hard exudates did not occur in eyes with subretinal washout, but occurred in 29 (57%) of the eyes without subretinal washout (p ≪ 0.0001) and in 15 eyes which had undergone reoperation with subretinal washout. Visual acuity improved in 54% of the subretinal washout eyes and 45% of the eyes without it. Visual acuity improved to 20/30 or better in 23% of the eyes with subretinal washout and in 8% of the eyes without subretinal washout. There was no serious complication related to subretinal washout.ConclusionsSubretinal washout for subtle subfoveal hard exudates in diabetic macular edema may prevent massive subfoveal exudates and improve visual results. Further study is needed to investigate the pathogenesis. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:369–374, 2003)

Surgical Removal of Subfoveal Hard Exudates in Diabetic Maculopathy

PURPOSE To examine the efficacy of surgical removal of subfoveal hard exudates during surgery in diabetic maculopathy. PATIENTS AND METHODS This study was done on 60 patients (66 eyes) that all underwent surgical removal of subfoveal hard exudates under the same surgeon. Thirty-two men (37 eyes) and 28 women (29 eyes) were included in this study. The average age of the patients was 60 years (range, 30-77 years). The average follow-up period was 21 months (range, 12-48 months). All eyes were classified into 3 groups: 13 postoperative massive type eyes, 31 massive type eyes, and 22 scatter type eyes. We evaluated the visual results of these types. RESULTS Preoperative and postoperative mean visual acuity was as follows: postoperative massive type 0.11, 0.22, massive type 0.12, 0.29, and scatter type 0.19, 0.33. Postoperatively visual acuity improved significantly in all types. There were no subfoveal hard exudates postoperatively in any eyes. CONCLUSION Surgical removal of massive subfoveal hard exudates is effective, but its effects on vision are limited. Surgical removal of deposited subfoveal hard exudates may prevent massive subfoveal hard exudates postoperatively and improve visual prognosis.