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INFLUENCE OF VITRECTOMY SURGERY ON THE INTEGRITY OF OUTER RETINAL LAYERS IN DIABETIC MACULAR EDEMA

Uji, Akihito, MD; Murakami, Tomoaki, MD; Suzuma, Kiyoshi, MD; Yoshitake, Shin, MD; Arichika, Shigeta, MD; Ghashut, Rima, MD; Fujimoto, Masahiro, MD; Yoshimura, Nagahisa, MD

doi: 10.1097/IAE.0000000000001519
Original Study
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Purpose: To investigate the influence of pars plana vitrectomy (PPV) on the integrity of photoreceptor layers in eyes with diabetic macular edema (DME) by using parallelism (a parameter that comprehensively reflects photoreceptor–retinal pigment epithelium [RPE] complex alterations) in spectral-domain optical coherence tomography (SD-OCT) imaging.

Methods: A consecutive series of 64 eyes in 55 patients with diabetic macular edema who underwent pars plana vitrectomy were recruited into the study. Spectral-domain optical coherence tomography images were obtained preoperatively and 6 months after surgery. The morphologic features of the outer retinal layers were assessed quantitatively using parallelism and qualitatively by graders, including continuity of the external limiting membrane (ELM) line, continuity of the photoreceptor inner and outer segment (IS/OS) junction line, and the presence of hyperreflective foci in the outer retinal layers. The relationships between parallelism, visual acuity (VA), and photoreceptor layer status were evaluated.

Results: After surgery, foveal thickness significantly decreased (P < 0.0001) and visual acuity improved (P < 0.0001) from baseline level. Postoperative parallelism (0.632 ± 0.137) was significantly higher than preoperative parallelism (0.531 ± 0.172) (P < 0.0001). A number of eyes with hyperreflective foci reduced after surgery, while separate evaluation of the inner and outer segment junction and external limiting membrane lines did not show significant changes. Moreover, preoperative and postoperative parallelism values showed significant correlations with postoperative visual acuity and serum lipid levels. Foveal thickness and logMAR visual acuity did not show significant correlations with any blood test data.

Conclusion: Pars plana vitrectomy might be effective for resolution of hyperreflective foci in outer retinal layers. Parallelism is a potential marker for localization of hyperreflective foci and useful as a predictive factor for postoperative visual acuity.

Pars plana vitrectomy led to the clearance of hyperreflective foci in outer retinal layers. Both preoperative and postoperative parallelism, an optical coherence tomography parameter for quantitative evaluation of photoreceptor–retinal pigment epithelium complex alterations, showed significant correlations with postoperative visual acuity and preoperative serum lipid levels.

Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Reprint requests: Akihito Uji, MD, Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; e-mail: akihito1@kuhp.kyoto-u.ac.jp

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.