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. 2017 Nov 23:11:2099-2105.
doi: 10.2147/OPTH.S150385. eCollection 2017.

Six-month postoperative outcomes of intraoperative OCT-guided surgical cystotomy for refractory cystoid macular edema in diabetic eyes

Yuichi Asahina  1 , Naoko Tachi  1 , Yumi Asahina  1 , Kayoko Yoshimura  1 , Yoshiki Ueta  1 , Yoshihiro Hashimoto  1
Affiliations

Six-month postoperative outcomes of intraoperative OCT-guided surgical cystotomy for refractory cystoid macular edema in diabetic eyes

Yuichi Asahina et al. Clin Ophthalmol. .

Abstract

Purpose: This study evaluated the outcomes of surgical cystotomy for recurrent diabetic cystoid macular edema (CME).

Patients and methods: We analyzed 20 eyes with a clinical diagnosis of diabetic retinopathy and refractory CME. Release of vitreoretinal adhesion, epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling and cystotomy guided by intraoperative optical coherence tomography (iOCT) were performed in every patient. Pars plana vitrectomy was also performed in 17 patients, 11 of whom also underwent lensectomy and intraocular lens implantation. Central retinal thickness (CRT), central minimum macular thickness (CMMT), macular volume (MV) and best-corrected visual acuity (BCVA) were compared preoperatively and 1 and 6 months post surgery.

Results: CRT, CMMT and MV significantly improved 1 and 6 months post surgery in each group (P<0.01). Significant improvements in BCVA were only observed 6 months post surgery (P<0.01). No intra- or postoperative complications were observed in all patients.

Conclusion: CRT, CMMT, MV and BCVA significantly improved 6 months following surgical cystectomy. This implies that iOCT-guided cystotomy could be another treatment option for refractory CME in diabetic eyes.

Keywords: cystoid macular edema; cystotomy; diabetic retinopathy; intraoperative OCT.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Surgical method for cystotomy for refractory DME. Notes: After core vitrectomy and removal of the ILM, the temporal margin of the cystoid space was vertically incised using a 27-gage needle (A), followed by an additional horizontal incision (B) and flushing the subfovea with 50–100 μL BSS. The arrow indicates the capsule that floated out from the retina while flushing BSS into the fovea, assumedly containing subretinal fluid (C). Resolution of CME was achieved (D). The magnification of images is ×25. Abbreviations: DME, diabetic macular edema; ILM, internal limiting membrane; BSS, balanced salt solution; CME, cystoid macular edema.
Figure 2
Figure 2
Changes in the CRT before surgery and 1 month and 6 months after surgery. Note: The bars and the asterisk indicate significant changes between two periods (P<0.01). Abbreviation: CRT, central retinal thickness.
Figure 3
Figure 3
Changes in the CMMT before surgery and 1 month and 6 months after surgery. Note: The bars and the asterisk indicate significant changes between two periods (P<0.01). Abbreviation: CMMT, central minimum macular thickness.
Figure 4
Figure 4
Changes in the MV before surgery and 1 month and 6 months after surgery. Note: The bars and the asterisk indicate significant changes between two periods (P<0.01). Abbreviation: MV, macular volume.
Figure 5
Figure 5
Preoperative and postoperative BCVA of 20 eyes that underwent cystotomy for refractory DME. Note: Only 19 eyes are presented on the scatterplot because two eyes had a preoperative and postoperative BCVA of 0.398. Abbreviations: BCVA, best-corrected visual acuity; DME, diabetic macular edema; logMAR, logarithm of the minimum angle of resolution; PPV, pars plana vitrectomy.
Figure 6
Figure 6
Spectral-domain OCT results of cystotomy in patient 20. Notes: Patient 20 was a 66-year-old female diagnosed with diabetes mellitus at 60 years of age. She developed recurrent macular edema after panretinal photocoagulation even after seven anti-VEGF intravitreal injections and six sub-Tenon’s capsule injections of corticosteroids. (A) Before surgery, showing apparent cystic macular edema. The CRT was 555 μm, and BCVA (logMAR) was 0.301. (B) Two days after surgery, showing successful incision of the foveal cyst. (C) One month after surgery, showing the foveal contour gradually recovering. (D) Six months after surgery, showing complete regression of CME. The CRT was 385 μm, and BCVA (logMAR) was 0.000. (E) An intraoperative OCT image showing the fovea after incision of the cyst. Abbreviations: OCT, optical coherence tomography; CRT, central retinal thickness; BCVA, best-corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; CME, cystoid macular edema.
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