https://doi.org/10.31288/oftalmolzh201752633

Changes in the retinal thickness after microinvasive vitrectomy with inner limiting membrane removal in patients with diabetic retinopathy

M.I.Kerimov

National Centre of Ophthalmology named after acad. Zarifa Aliyeva

Baku (Azerbaijan)

E-mail: mushfikk@mail.ru                

The purpose. To study changes in the macular retinal thickness in patients with diabetic retinopathy after microinvasive vitrectomy with inner limiting membrane (ILM) removal.

Material and Methods. This was a retrospective analysis of spectral OCT data of the macula of eighty-eight eyes (77 patients) after 23 gauge vitrectomy for proliferative diabetic retinopathy.  The surgeries were performed at National Centre of Ophthalmology named after acad. Zarifa Aliyeva, Baku, Azerbaijan, in the period between 2010 and 2015. Study group comprised fifty-nine eyes in which vitrectomy was performed with ILM removal; Control group comprised thirty eyes in which ILM was not removed during the surgery. ILM was peeled using ILM forceps (Alcon, the USA) after brilliant blue G (BBG) staining. For statistical analysis, we used three Cirrus-HD OCT measurements: central (1 mm), inner temporal (1-3 mm), and inner nasal (1-3 mm) retinal thickness.   

Results. At 12 months after surgery, the mean macular thickness in the inner temporal subfield was much thinner in the eyes with ILM removal than in those without ILM removal, 279±51.9 ?m vs. 332±93.8 ?m, (p=0,002), respectively. The macular thickness in the central, foveolar subfield almost did not differ in different groups as well as the thickness in the inner nasal subfield (p>0.05 in both cases). Since there was not a healthy paired eye, we compared our data with the normative data obtained from the paper by Liu et al [2011], in which Cirrus HD OCT showed the macular thickness in the inner temporal subfield equal to 313.4±18.5 ?m in diabetic patients without retinopathy signs, which was significantly higher than in our patients after vitrectomy with ILM removal (295±43.1 ?m, p=0.002). And the macular thickness in the nasal and central foveal subfields did not differ significantly from our data.

Conclusions. We revealed thinning of the macular temporal subfield after vitrectomy with ILM removal not only in patients with diabetic macular edema but also with tractional retinal detachment and vitreous hemorrhage. Our data confirm, once again, a universal character of the asymmetric changes in the macular thickness in the temporal and nasal subfields after vitrectomy with ILM removal for various pathological changes in the retina. However, to clarify the practical meaning of this phenomenon, the further functional investigations are required.    

Key-words: retinal thickness, vitrectomy with inner limiting membrane removal, diabetic retinopathy    

References

1.     Yau JWY, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556–564.
        Crossref   Pubmed

2.     Scanlon PH, Aldington SJ, Stratton IM. Epidemiological issues in diabetic retinopathy. Middle East Afr J Ophthalmol. 2013 Oct-Dec;20(4):293-300.
        Crossref   Pubmed

3.     Couch SM, Sophie J Bakri SJ. Use of triamcinolone during vitrectomy surgery to visualize membranes and vitreous. Clin Ophthalmol. 2008 Dec; 2(4): 891–896.
        Crossref   Pubmed

4.     Park DH, Shin JP, Kim SY. Comparison of clinical outcomes between 23-gauge and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy. Retina. 2010;30:1662–70.
        Crossref   Pubmed

5.     Schoenberger SD, Miller DM, Riemann CD, et al. Outcomes of 25-gauge pars plana vitrectomy in the surgical management of proliferative diabetic retinopathy. Ophthalmol Surg Laser Imag- ing. 2011;42(6):474–80. 
        Crossref   Pubmed

6.     Hern?ndez F, Alpizar-Alvarez N, Wu L. Chromovitrectomy: an Update. J Ophthalmic Vis Res. 2014 Apr; 9(2): 251–259.

7.     Mester V, Kuhn F. Internal limiting membrane removal in the management of full-thickness macular holes. Am J Ophthalmol. 2000;129:767-777.
        Crossref   Pubmed

8.     Park DW, Dugel PU, Garda J, et al. Macular pucker removal with and without internal limiting membrane peeling: pilot study. Ophthalmology. 2003;110:62-64.
        Crossref   Pubmed

9.     Kwok AK, Lai TY, Li WW, et al. Indocyanine green-assisted internal limiting membrane removal in epiretinal membrane surgery: a clinical and histologic study. Am J Ophthalmol. 2004;138:194-199.
        Crossref   Pubmed

10.  Rao RC, Blinder KJ, Smith BT, Shah GK. Internal limiting membrane peeling for primary rhegmatogenous retinal detachment repair. Ophthalmology. 2013 May;120(5):1102-3.e1-2.
        Crossref   Pubmed

11.  Nam KY, Kim JY. Effect of internal limiting membrane peeling on the development of epiretinal membrane after pars plana vitrectomy for primary rhegmatogenous retinal detachment. Retina. 2015 May;35(5):880-5.
        Crossref   Pubmed

12.  Akiyama K, Fujinami K, Watanabe K, Tsunoda K, Noda T. Internal Limiting Membrane Peeling to Prevent Post-vitrectomy Epiretinal Membrane Development in Retinal Detachment. Am J Ophthalmol. 2016 Nov;171:1-10.
        Crossref   Pubmed

13.  Michalewska Z, Bednarski M, Michalewski J, Jerzy N. The role of ILM peeling in vitreous surgery for proliferative diabetic retinopathy complications. Ophthalmic Surg Lasers Imaging Retina. 2013 May-Jun;44(3):238-42.
        Crossref   Pubmed

14.  Tadayoni R, Paques M, Massin P, et al. Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal. Ophthalmology 2001;108: 2279–2283.
        Crossref   Pubmed

15.  Kumagai K, Ogino N, Furukawa M, Hangai M, Kazama S, Nishigaki S, Larson E. Retinal thickness after vitrectomy and internal limiting membrane peeling for macular hole and epiretinal membrane. Clin Ophthalmol. 2012;6:679-88.
        Crossref   Pubmed

16.  Pichi F, Lembo A, Morara M, Veronese C, Alkabes M, Nucci P, Ciardella AP. Early and late inner retinal changes after inner limiting membrane peeling. Int Ophthalmol. 2014 Apr;34(2):437-46.

17.  Yoshikawa M, Murakami T, Nishijima K, Uji A, Ogino K, Horii T, Yoshimura N. Macular migration toward the optic disc after inner limiting membrane peeling for diabetic macular edema. Invest Ophthalmol Vis Sci. 2013 Jan 21;54(1):629-35.

18.  Liu T, Hu AY, Kaines A, Yu F, Schwartz SD, Hubschman JP. A pilot study of normative data for macular thickness and volume measurements using cirrus high-definition optical coherence tomography. Retina. 2011 Oct;31(9):1944-50.

19.  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 (2):126–133.

20.  Mitamura Y, Suzuki T, Kinoshita T, N. Miyano N, Tashimo A, Ohtsuka K. Optical coherence tomographic findings of dissociated optic nerve fiber layer appearance American Journal of Ophthalmology, 2004 vol. 137, no. 6, pp. 1155–1156.

21.  Ito Y, Terasaki H, Takahashi A, Yamakoshi T, Kondo M, Nakamura M. “Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes,” Ophthalmology 2005, vol. 112, no. 8, pp. 1415–1420. ?

22.  Rubinstein A, Bates R, Benjamin L, Shaikh A. Iatrogenic eccentric full thickness macular holes following vitrectomy with ILM peeling for idiopathic macular holes. Eye (Lond). 2005 Dec;19(12):1333-5.

23.  Ohta K, Sato A, Fukui E. Asymmetrical thickness of parafoveal retina around surgically closed macular hole. Br J Ophthalmol. 2010;94:1545–1546.

24.  Sandali O, El Sanharawi M, Basli E, Lecuen N, Bonnel S, Borderie V, Laroche L, Monin C. Paracentral retinal holes occurring after macular surgery: incidence, clinical features, and evolution. Graefes Arch Clin Exp Ophthalmol. 2012 Aug;250(8):1137-42.

25.  Kawano K, Ito Y, Kondo M, Ishikawa K, Kachi S, Ueno S, Iguchi Y, Terasaki H. Displacement of foveal area toward optic disc after macular hole surgery with internal limiting membrane peeling. Eye (Lond). 2013 Jul;27(7):871-7.

26.  Mason JO 3rd, Feist RM, Albert MA Jr. Eccentric macular holes after vitrectomy with peeling of epimacular proliferation. Retina. 2007 Jan;27(1):45-8.

27.  Rush RB, Simunovic MP, Aragon AV 2nd, Ysasaga JE. Postoperative macular hole formation after vitrectomy with internal limiting membrane peeling for the treatment of epiretinal membrane. Retina. 2014 May;34(5):890-6.