RESUMO
ABSTRACT Purpose: To evaluate whether baseline spectral-domain optical coherence tomography characteristics of intraretinal cystoid spaces predict visual outcomes in patients receiving intravitreal antivascular endothelial growth factor injection therapy (bevacizumab 1.25mg/0.05ml) for diabetic cystoid macular edema. Methods: The relationship between the properties of the cystoid spaces before injection and anatomic and functional results after injection were investigated in patients who received three consecutive intravitreal bevacizumab injections for cystoid macular edema. The best-corrected visual acuity for functional success and central subfield thickness for anatomical success were evaluated. The relationship of the location of the cystoid spaces with the integrity of photoreceptors and inner retinal layers was also evaluated. Results: In 36 eyes of 36 patients, the mean best-corrected visual acuity significantly improved (p=0.002), and mean central subfield thickness decreased after injections (p=0.003). The improvement in best-corrected visual acuity was limited in eyes with outer nuclear layer cysts (p=0.045). Intracystic reflectivity was higher in eyes that poor best-corrected visual acuity than in eyes with successful visual outcomes (p=0.028). The disrupted ellipsoid zone was present in 13 (59.0%) of 22 eyes with outer nuclear layer cysts, whereas in only 1 of 14 eyes (7.1%) without outer nuclear layer cysts (p=0.009). Disorganization of retinal inner layers was present in 15 of 22 (68.1%) eyes with outer nuclear layer cysts, whereas only 2 of 14 (14.2%) without outer nuclear layer cysts had disorganization of retinal inner layers (p=0.013). Conclusion: Characteristics of intraretinal cystoid spaces may predict prognosis in patients with diabetic cystoid macular edema, and visual gain may be limited in the eyes with outer nuclear layer cysts.
RESUMO Objetivo: Avaliar se as características da tomografia de coerência óptica de domínio espectral dos espaços cistoides intraretinianos prevêem resultados visuais em pacientes que recebem terapia de injeção intravítrea com fator de crescimento endotelial antivascular (bevacizumab 1,25 mg/0,05 ml) para edema macular cistoide diabético. Métodos: A relação entre as propriedades dos espaços cistoides antes da injeção e os resultados anatômicos e funcionais após a injeção foi investigada em pacientes que receberam três injeções intravítreas para edema macular cistoide. A melhor acuidade visual corrigida para a melhora funcional e a espessura do subcampo central para a melhora anatômica foram avaliadas. Além disso, foi avaliada a relação da localização dos espaços cistoides com a integridade dos fotorreceptores e camadas internas da retina. Resultados: Em 36 olhos de 36 pacientes, a melhor acuidade visual corrigida foi significativamente aprimorada (p=0,002), e a espessura média do subcampo central foi diminuída após injeções (p=0,003). O aprimoramento da melhor acuidade visual corrigida foi limitado nos olhos com cistos na camada nuclear externa (p=0,045). A reflexividade intracística foi maior nos olhos que falharam na melhor acuidade visual corrigida do que nos olhos com resultados visuais bem-sucedidos (p=0,028). A zona elipsoide interrompida esteve presente em 13 (59,0%) de 22 olhos com cistos na camada nuclear externa, e em apenas 1 de 14 olhos (7,1%) sem cistos na camada nuclear externa (p=0,009). A desorganização das camadas internas da retina esteve presente em 15 dos 22 olhos (68,1%) com cistos na camada nuclear externa, enquanto apenas 2 em 14 olhos (14,2%) sem cistos na camada nuclear externa tiveram desorganização das camadas internas da retina (p=0,013). Conclusão: Características dos espaços cistoides intrarretinianos podem prever prognóstico em pacientes com edema macular cistoide diabético e ganho visual pode ser limitado nos olhos com cistos na camada nuclear externa.
RESUMO
PURPOSE: To evaluate whether baseline spectral-domain optical coherence tomography characteristics of intraretinal cystoid spaces predict visual outcomes in patients receiving intravitreal antivascular endothelial growth factor injection therapy (bevacizumab 1.25mg/0.05ml) for diabetic cystoid macular edema. METHODS: The relationship between the properties of the cystoid spaces before injection and anatomic and functional results after injection were investigated in patients who received three consecutive intravitreal bevacizumab injections for cystoid macular edema. The best-corrected visual acuity for functional success and central subfield thickness for anatomical success were evaluated. The relationship of the location of the cystoid spaces with the integrity of photoreceptors and inner retinal layers was also evaluated. RESULTS: In 36 eyes of 36 patients, the mean best-corrected visual acuity significantly improved (p=0.002), and mean central subfield thickness decreased after injections (p=0.003). The improvement in best-corrected visual acuity was limited in eyes with outer nuclear layer cysts (p=0.045). Intracystic reflectivity was higher in eyes that poor best-corrected visual acuity than in eyes with successful visual outcomes (p=0.028). The disrupted ellipsoid zone was present in 13 (59.0%) of 22 eyes with outer nuclear layer cysts, whereas in only 1 of 14 eyes (7.1%) without outer nuclear layer cysts (p=0.009). Disorganization of retinal inner layers was present in 15 of 22 (68.1%) eyes with outer nuclear layer cysts, whereas only 2 of 14 (14.2%) without outer nuclear layer cysts had disorganization of retinal inner layers (p=0.013). CONCLUSION: Characteristics of intraretinal cystoid spaces may predict prognosis in patients with diabetic cystoid macular edema, and visual gain may be limited in the eyes with outer nuclear layer cysts.
RESUMO
PURPOSE: To evaluate the effect of internal limiting membrane (ILM) peeling on anatomical and functional results in pars plana vitrectomy performed eyes with tractional retinal detachment affecting the macula because of diabetes mellitus. METHODS: Patients without ILM peeling were considered as Group 1, and patients with ILM peeling were considered as Group 2. The main outcomes were the best-corrected visual acuity at 6 months and the rate of epiretinal membrane formation within 6 months. The rate and the indications for resurgery were determined. Parameters affecting the final best-corrected visual acuity were determined by regression analysis. RESULTS: Final best-corrected visual acuity was significantly better in eyes with ILM peeled off than in eyes with no peel-off ( P = 0.012). Less secondary epiretinal membrane was formed in Group 1 ( P = 0.009). There was no difference between groups in resurgery rates ( P = 0.143). The need for resurgery because of epiretinal membrane was higher in Group 1 rather than Group 2 ( P = 0.001). The only factor affecting the final best-corrected visual acuity was ILM peeling. CONCLUSION: In patients with tractional retinal detachment affecting the macula because of diabetes, ILM peeling in addition to pars plana vitrectomy and membrane excision does not affect the need for resurgery but contributes positively to anatomical and functional outcomes.
