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O. S. Faridi, S. Yalamanchi, K. A. Drenser, G. A. Williams; Chronic Macular Cystoid Degeneration in Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1329.
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© ARVO (1962-2015); The Authors (2016-present)
To report the presence of chronic retinal degeneration in proliferative diabetic retinopathy (PDR), measured with optical coherence tomography (OCT) after pars plana vitrectomy for repair of tractional retinal detachment (TRD) involving the macula.
This is a retrospective case series in which five charts of patients who underwent pars plana vitrectomy for repair of TRD secondary to PDR between 1998-2008 at William Beaumont Hospital were reviewed. Outcome measures utilized for assessment included pre- and post-operative visual acuity, clinical examination, and OCT.
Five patients diagnosed with insulin dependent diabetes mellitus with an average age of 55 (ranging 29-68 years of age) at the time of pars plana vitrectomy were studied. The mean pre-operative visual acuity was 20/150. OCT demonstrated TRD with cystic macular degeneration in all five patients prior to vitrectomy. All patients underwent pars plana vitrectomy with successful release of traction and re-apposition of the retina. Three patients demonstrated improved visual acuity by one line, one patient had stable vision, and one patient had decreased visual acuity by two lines when compared to pre-operative recordings. OCT evaluation post-vitrectomy indicated resolution of traction and persistent cystic degenerative changes in all five patients.
Chronic cystic macular degeneration may be observed by OCT after repair of TRD involving the macula secondary to PDR. These findings suggest that removal of traction does not resolve chronic retinal degeneration correlating with possible irreversible damage to structure and function. This degeneration is not evident on clinical examination, and post-vitrectomy OCT is a useful evaluation for patients with impaired visual recovery. The presence of macular cystic degeneration may ultimately indicate a less favorable response to vitrectomy and raises consideration for earlier timing of vitrectomy in diabetic patients.
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