Yi-Ting Hsieh

Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression.

The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68–5.37) and 9.7 (95% CI = 8.15–11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68–3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10–1.38 with NPDR; HR = 1.33, 95% CI = 1.02–1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72–2.41 in NPDR; HR = 2.95, 95% CI = 2.16–4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87–2.48) or progression (HR = 0.37, 95% CI = 0.11–1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation.

EPIRETINAL MEMBRANE-INDUCED FULL-THICKNESS MACULAR HOLES: The Clinical Features and Surgical Outcomes.

Purpose: To investigate the clinical features and surgical outcomes in patients with epiretinal membrane–induced full-thickness macular holes (FTMHs). Methods: Consecutive cases with epiretinal membrane–induced FTMH followed by a single surgeon were retrospectively reviewed (study group, 24 cases). The criteria of epiretinal membrane–induced FTMH selection were 1) documented lamellar macular hole before FTMH formation, 2) FTMH with lamellar hole–associated epiretinal proliferation at the hole edge, and 3) FTMH with wider inner opening and narrower base. Consecutively treated Stage 2 (Control A, 20 cases) and Stage 4 (Control B, 22 cases) MH patients served as controls. All patients were followed up for at least 12 months after treatment. Results: Patients in the study group were younger and had a higher rate of high myopia than Controls A and B. The average hole size (203.6 ± 104.9 &mgr;m) was similar to that in Control A group and smaller than that in Control B group; the postoperative visual improvement (2–3 lines in Early Treatment Diabetic Retinopathy Study) was lower than that in Control A and B groups. Similar results were found when excluding high myopia cases from the study group. Conclusion: Epiretinal membrane–induced FTMH has distinct features from the typical Stage 2 or 4 FTMH. Despite the small size, visual improvement is not as good as that in Stage 2 FTMH.

Combined Tractional and Rhegmatogenous Retinal Detachment in Proliferative Diabetic Retinopathy in the Anti-VEGF Era

Purpose. To investigate the clinical features, surgical outcomes, and prognostic factors of combined rhegmatogenous and tractional detachment (combined RD) in proliferative diabetic retinopathy (PDR) in recent years. Methods. Medical records of PDR and combined RD treated with vitrectomy from 2008 to 2013 were retrospectively reviewed. Results. A total of 57 eyes from 49 patients were included. Nine eyes had received panretinal photocoagulation (PRP) and 7 eyes had intravitreal bevacizumab (IVB) within 3 months before RD developed. Thirty-eight eyes (66.7%) had ≧3 sites of broad adhesion of fibrovascular proliferation (FVP). Thirty-three eyes (57.9%) showed active FVP. Thirty-four eyes (59.6%) had extent of RD involving 3 or 4 quadrants. The primary reattachment rate was 93.0%, and the final visual acuity (VA) improved by more than 3 lines in 80.7% of eyes. Neovascular glaucoma occurred in 4 eyes postoperatively. Poor preoperative VA, severe vitreoretinal adhesion, and broad extent of RD had significant correlation with poor visual outcomes. Conclusion. PRP or IVB might play a role in provoking combined RD. The anatomical and functional success rates of surgery were high. Poor preoperative VA and severe proliferations predicted poor visual outcomes.

Development of diabetic retinopathy after cataract surgery

This study explored whether cataract surgery precipitates diabetic retinopathy (DR) development in diabetic patients without previous DR. Patients with the diagnosis of type II diabetes but without DR were selected from the Longitudinal Health Insurance Database 2000. Patients who received cataract surgery between January 1, 2000, and December 31, 2010, were included in the case group, and the control group was matched to the case group by age, sex, and index year. The postoperative incidence rates of nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), and diabetic macular edema (DME) were the main outcomes studied and were adjusted by age, sex, comorbidities, and statin, fibrate, angiotensin-converting-enzyme inhibitor (ACEI), oral hypoglycemic agents (OHA), and insulin use. In our cohort, patients who had dyslipidemia and used statins were more likely to undergo cataract surgery. Among diabetic patients without previous DR, patients receiving cataract surgery had a higher risk of NDPR development (adjusted hazard ratio = 1.48, 95% confidence interval = 1.15–1.91). No statistical difference was observed in PDR or DME development between operative and nonoperative groups. In additional stratified analyses, female sex, older age, comorbidities, surgery within 5 years, statin, ACEI, OHA, and insulin use increased the risk of NPDR development. In an adjusted Cox regression model, cataract surgery, OHA and insulin use were found to be risk factors for NPDR development. Cataract surgery with complications increased post-operative risks for NPDR were even higher, and the significant influence from cataract surgery persisted 5 years after surgery.

Multiple Free Internal Limiting Membrane Flap Insertion in the Treatment of Macular Hole-Associated Retinal Detachment in High Myopia

Purpose: The aim of this paper was to evaluate the efficacy of multiple free internal limiting membrane (ILM) flap insertion in the management of macular hole-associated retinal detachment in high myopia. Procedures: Eyes receiving operation for macular hole-associated retinal detachment were retrospectively recruited. Those in the study group received ILM peeling and multiple free ILM flap insertion, while those in the control group received ILM peeling only. Postoperative anatomical outcomes and best-corrected visual acuity were compared between the 2 groups. Results: Twenty-seven eyes of 27 patients were recruited in this study (13 in the study group, 14 in the control group). After the operation, the retina was reattached in all cases in both groups. The macular hole closure rate was 100% in the study group but only 42.9% in the control group (adjusted p < 0.001). The eyes in the study group had better visual improvement (logMAR –0.58 ± 0.43) than those in the control group (logMAR –0.31 ± 0.50) with borderline significance (adjusted p = 0.078). Conclusions: For macular hole-associated retinal detachment in highly myopic eyes, the multiple free ILM flap insertion technique offers an effective way to close macular holes. Whether this result also means better visual outcome remains to be seen.

Posterior subtenon injection of triamcinolone acetonide for pseudophakic cystoid macular oedema.

because other authors and we could recently show that spontaneous resolution of vitreomacular traction (VMT) is indeed much more common than we thought earlier (Dimopoulos et al. 2015). 2) In our subgroup analysis regarding positive predictive parameters, we could show slightly better results than other studies underlining the importance of patient selection. 3) We could not observe any patient with a macular hole profiting from this treatment. This is important because improvement in best corrected visual acuity (BCVA) in patients suffering from macular holes is time dependent. However, the number of patients with a macular hole is rather small. Other studies showed better closure rates such as the MIVI-Trust studies with a non-surgical closure rate with 43 of 106 (40.6%) (Stalmans et al. 2012). Indeed, recent publications show a various large variance considering the closure rates of full-thickness macular holes, ranging from 2.7% (n = 9) (Moisseiev et al. 2014) to 4 of 15 (27%) (Sharma et al. 2015). The relevance of face-down or no face-position is a factor that might also influence the outcome. However, face-down position was shown to be not of substantial influence on outcome after vitrectomy in macular holes smaller 400 lm (Hu et al. 2016). Therefore, we strongly recommend further investigation in the treatment of full-thickness macular holes with larger sample size. The results of this study especially in the light of new insights into the natural course of VMT stress that meticulous patient selection is the most important factor for a potential success if a decision for an injection with JETREA is chosen.

Autofluorescence-delineated macular hole size predicts postoperative visual outcome.

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