Purchase this article with an account.
M. T. Trese, L. Ho, T. Asami; The Diabetic Vitreoretinal Juncture: Composition, Classification and MIVI II-DME Trial Results. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4656.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
to describe the composition of the diabetic vitreoretinal juncture (VRJ), Propose a classification system for the diabetic VRJ, and apply to the MIVI II-DME trial results
An analysis of the composition of the VRJ and how it changes over time as well as a proposed classification system of the VRJ in diabetic eyes based on duration of known diabetes, HbA1C, previous laser treatment and area of VR attachment. This system is then used to analyze human eyes of diabetic patients in the MIVI II-DME trial of Microplasmin. This included 51 eyes of 51 patients in a dose escalating (25, 75,125 micrograms) sham controlled trial.
show that the composition of the diabetic VRJ vary based on an increased production of fibronectin, laminin and type 4 collagen with exposure to hyperglycemia over time. This change in composition is the most likely the reason for diabetic eyes developing vitreoschisis of the posterior hyaloid. A classification system based on duration of diabetes, HBA1C values, area of attachment and previous laser treatment may predict who will respond to enzymatic cleavage of the VRJ. The MIVI II-DME study without any systematic analysis of the population showed that some eyes (11-17%) could cleave the diabetic VRJ with Microplasmin alone by OCT and Ultrasound criteria. Careful case selection can cause the cleavage rate to increase.
A better understanding of the anatomic composition and classification of vitreoretinal juncture of diabetic eyes can aid in choosing therapy to cleave the vitreoretinal juncture by enzyme or surgery or a combination of both
Clinical Trial: :
This PDF is available to Subscribers Only