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Y Saito, Y Kiuchi, K Nakae, Y Shiotani, N Hamanaka, A Suzuki, T Tokoro, T Hashitani, Y Tano; Vitrectomy With Subretinal Lavage for Removal of Hard Exudates and Subretinal Fluid in Eyes With Severe Diabetic Retinal Edema . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3515.
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Purpose: Although vitrectomy has been widely accepted for diffuse diabetic macular edema, it is not always effective for severe, extensive macular edema that is wider than the vascular arcade, and the iris rubeosis may worsen after the surgery. We have developed a subretinal lavage technique for removing subretinal fluid and mobile hard exudates. Methods: In 7 eyes that underwent vitrectomy with planned subretinal lavage, 4 eyes were confirmed to have marked retinal edema (detachment) and mobile hard exudates in the subretinal space dring the surgery. In these 4 eyes, an intentional retinal hole was made superior to the macula, and saline was injected subretinally with a back-flush needle creating a bullous retinal detachment. This was followed by passive aspiration of the subretinal fluid during which a large number of the hard exudates were aspirated from the subretinal space. Fluid-air exchange and endophotocoagulation were then performed. The vitreous cavity was filled with 20% SF6. Results: After the vitrectomy and subretinal lavage, the rubeosis iridis disappeared and retinal edema dramatically improved in all eyes. Additional photocoagulation where marked edema had existed became possible 2 weeks after the surgery. Although one eye developed preretinal proliferation, the retina remained stabilized and quiescent long after the surgery. The visual acuity improved in 2 eyes 1 year after the surgery. Conclusion: Intentional drainage of subretinal fluid and mobile hard exudates that may contain VEGF or other active components was effective for the prompt reduction of marked retinal edema that revealed the retinal detachment. Vitrectomy, subretinal lavage, and endophotocoagulation that rapidly improved the retinal ischemia is a new technique for some cases of severe diabetic retinal edema.
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