The role of the posterior vitreous detachment in diabetic macular edema

Abstract

Introduction: In this study, we aimed to evaluate the effect of the presence of total posterior vitreous detachment (PVD) on the formation of macular edema in patients with diabetic retinopathy together with other risk factors. Material and Method: 166 eyes of 103 patients with diabetic retinopathy were prospectively included in the study. 96 eyes of 58 patients with macular edema (group 1) and 70 eyes of 45 patients without macular edema (group 2) were compared in terms of the presence of PVD and other risk factors. Results: The mean age was 61.8±5.5 in the first group and 63.6±7.2 in the second group (p> 0.05). There was no significant difference between the two groups in terms of female/male ratio and duration of diabetes. PVD was found in 11 (11.45%) of 96 eyes with macular edema and 8 (11.42%) of 70 eyes without macular edema. There was no statistically significant difference in terms of PVD rates in both groups (χ2 = 0.9953, p> 0.05). Proliferative diabetic retinopathy rates, presence of hypertension and proteinuria, fasting blood glucose, urea, creatinine and HbA1c rates were compared in the two groups. Insulin use rate was higher in the second group (p <0.001). Conclusion: In our study, there was no significant difference between PVD rates in the groups with and without macular edema. Therefore, we concluded that the presence of PVD is not a protective factor against macular edema. Pathogenesis of diabetic macular edema is multifactorial. In order to understand the role of posterior vitreous detachment on macular edema, larger-scale studies that follow macular edema for a long time should be done.

Keywords

• iabetic retinopathy
• macular edema
• posterior vitreous detachment

Diyabetik maküla ödeminde arka vitreus dekolmanının rolü

Abstract

Giriş: Bu çalışmada diyabetik retinopatisi olan olgularda total arka vitreus dekolmanı (PVD) varlığının maküla ödemi oluşumu üzerine olan etkisini diğer risk faktörleriyle birlikte değerlendirmeyi amaçladık Gereç ve Yöntem: Diyabetik retinopatili 103 hastanın 166 gözü prospektif olarak çalışma kapsamına alındı. Maküla ödemi olan 58 hastanın 96 gözü (grup 1) ve maküla ödemi olmayan 45 hastanın 70 gözü (grup2) PVD varlığı ve diğer risk faktörleri açısından karşılaştırıldı. Bulgular: Yaş ortalamaları 1.grupta 61,8 ±5,5, 2.grupta 63,6±7,2 idi (p>0,05). İki grupta kadın/erkek oranı ve diyabet süreleri açısından anlamlı fark yoktu. Maküla ödemi olan 96 gözün 11’inde (%11,45), maküla ödemi olmayan 70 gözün 8’inde (%11,42) PVD bulundu. Her iki grupta PVD oranları açısından istatistiksel olarak anlamlı bir fark saptanmadı (χ2=0,9953, p>0,05). İki grupta proliferatif diyabetik retinopati oranları, hipertansiyon ve proteinüri varlığı, açlık kan şekeri, üre, kreatinin ve HbA1c oranları karşılaştırıldı. İki grup arasında anlamlı fark saptanmadı (p>0,05). İnsülin kullanma oranı 2.grupta fazla bulundu (p<0,001). Sonuç: Çalışmamızda, maküla ödemi olan ve maküla ödemi olmayan gruplarda PVD oranları arasında anlamlı fark saptanmadı. Bu nedenle PVD varlığının maküla ödemine karşı koruyucu bir faktör olmadığı kanısına vardık. Diyabetik maküla ödeminin patogenezi multifaktöriyeldir. Arka vitreus dekolmanının maküla ödemi üzerindeki rolünü anlamak için daha geniş çaplı ve maküla ödemini uzun süre takibe alan çalışmalar yapılmalıdır

Keywords

• Diyabetik retinopati
• maküla ödemi
• arka vitreus dekolmanı

References

1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. Ophthalmology 1984; 91: 1464-74.
2. McDonald HR, Schatz H. Macular edema following panretinal photocoagulation. Retina 1985; 5: 5-10.
3. Bursell SE, Delori FC, Yoshida A, Parker JS, Collas GD, McMeel JW. Vitreous fluorophotometric evaluation of diabetics. Invest Ophthalmol Vis Sci 1984; 25: 703-10.
4. Schepens CL, Avila MP, Jalkh AE, Trempe CL. Role of the vitreous in cystoid macular edema. Surv Ophthalmol 1984; 28 Suppl: 499-504.
5. Nasrallah FP, Jalkh AE, Van Coppenolle F, et al. The role of the vitreous in diabetic macular edema. Ophthalmology 1988; 95: 1335-9.
6. Nasrallah FP, Van de Velde F, Jalkh AE, Trempe CL, McMeel JW, Schepens CL. Importance of the vitreous in young diabetics with macular edema. Ophthalmology 1989; 96: 1511-6.
7. 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.
8. Tachi N, Ogino N. Vitrectomy for diffuse macular edema in cases of diabetic retinopathy. Am J Ophthalmol 1996; 122: 258-60.

9. Yang MC: Surgical treatment for severe diabetic macular edema with massive hard exudates. Retina 2000; 20: 121-5.
10. Yamaguchi Y, Otani T, Kishi S. Resolution of diabetic cystoid macular edema associated with spontaneous vitreofoveal separation. Am J Ophthalmol 2003; 135: 116–8.
11. Diaz-Llopis M, Udaondo P, Millán JM, Arevalo JF. Enzymatic vitrectomy for diabetic retinopathy and diabetic macular edema. World J Diabetes 2013; 4: 319-23.
12. Kado M, Jalkh AE, Yoshida A, et al. Vitreous changes and macular edema in central retinal vein occlusion. Ophthalmic Surg 1990; 21: 544-9.
13. Ünlü N, Kocaoğlan H, Sargın M, Kasım R, Duman S. Arka vitreus dekolmanın USG ve +78Dioptri lens ile değerlendirilmesi. T Oft Gaz 1993; 23: 138-40
14. Sebag J, Buckingham B, Charles MA, Reiser K. Biochemical abnormalities in vitreous of humans with proliferative diabetic retinopathy. Arch Ophthalmol 1992; 110: 1472-6.
15. Sebag J, Nie S, Reiser K, Charles MA, Yu NT. Raman spectroscopy of human vitreous in proliferative diabetic retinopathy. Invest Ophthalmol Vis Sci 1994; 35: 2976-80.
16. Sebag J, Balazs EA. Pathogenesis of cystoid macular edema: an anatomic consideration of vitreoretinal adhesions. Surv Ophthalmol 1984; 28 Suppl: 493-8.
17. Lewis H. The role of vitrectomy in the treatment of diabetic macular edema. Am J Ophthalmology 2001; 131: 123-5
18. Kaiser PK, Riemann CD, Sears JE, Lewis H. Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction. Am J Ophthalmol 2001; 131: 44-9.
19. Jumper JM, Embabi SN, Toth CA, McCuen BW II, Hatchell DL. Electron immunocytochemical analysis of posterior hyaloid associated with diabetic macular edema. Retina 2000; 20: 63-8.
20. Gaucher D, Tadayoni R, Erginay A, Haouchine B, Gaudric A, Massin P: Optical coherence tomography assessment of the vitreoretinal relationship in diabetic macular edema. Am J Ophthalmol 2005; 139: 807–13.
21. Ikeda T, Sato K, Katano T, Hayashi Y. Vitrectomy for cystoid macular oedema with attached posterior hyaloid membrane in patients with diabetes. Br J Ophthalmol 1999; 83: 12-4.
22. Ikeda T, Sato K, Katano T, Hayashi Y. Improved visual acuity following pars plana vitrectomy for diabetic cystoid macular edema and detached posterior hyaloid. Retina 2000; 20: 220-2.
23. Harbour JW, Smiddy WE, Flynn HW Jr, Rubsamen PE. Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol 1996; 121: 405-13.
24. Pendergast SD, Hassan TS, Williams GA, et al. Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol 2000; 130: 178-86.
25. La Heij EC, Hendrikse F, Kessels AG, Derhaag PJ. Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefes Arch Clin Exp Ophthalmol 2001; 239: 264-70.
26. Gandorfer A, Messmer EM, Ulbig MW, Kampik A. Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina 2000; 20: 126-33.
27. Otani T, Kishi S. Tomographic assessment of vitreous surgery for diabetic macular edema. Am J Ophthalmol 2000; 129: 487-94.
28. Kadonosono K, Itoh N, Ohno S. Perifoveal microcirculation before and after vitrectomy for diabetic cystoid macular edema. Am J Ophthalmol 2000 Dec; 130: 740-4.
29. Yamamoto T, Akabane N, Takeuchi S. Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol 2001; 132: 369-77.
30. Unal M, Peyman GA. The efficacy of plasminogen-urokinase combination in inducing posterior vitreous detachment. Retina 2000; 20: 69-75.
31. Bhisitkul RB. Anticipation for enzymatic vitreolysis. Br J Ophthalmol 2001; 85: 1-2.
32. Oliveira LB, Tatebayashi M, Mahmoud TH, Blackmon SM, Wong F, McCuen BW. 2nd. Dispase facilitates posterior vitreous detachment during vitrectomy in young pigs. Retina 2001; 21: 324-31.
33. Diaz-Llopis M, Udaondo P, Millán JM, Arevalo JF. Enzymatic vitrectomy for diabetic retinopathy and diabetic macular edema. World J Diabetes 2013; 4: 319-23.
34. Özsaygili C, Küçük B, Yildirim Y. The effect of posterior vitreous detachment on aflibercept response in diabetic macular oedema. Br J Ophthalmol 2021 Jun;105: 800-805.
35. Ali F, Kasi S, Saroj N, et al. Impact of Posterior Vitreous Detachment on Treatment Outcomes in Diabetic Macular Edema. Ophthalmol Retina 2020 Apr; 4: 452-454.
36. Hikichi T, Fujio N, Akiba J, Azuma Y, Takahashi M, Yoshida A. Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus. Ophthalmology 1997; 104: 473-8.