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      The Effect of Internal Limiting Membrane Cleaning on Epiretinal Membrane Formation after Vitrectomy for Proliferative Diabetic Retinopathy

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          Abstract

          Purpose: We hypothesised that cleaning the internal limiting membrane (ILM) with a flexible nitinol loop following diabetic vitrectomy without peeling may reduce the common occurrence of postoperative epiretinal membrane (ERM) formation. Methods: Consecutive patients undergoing vitrectomy for proliferative diabetic retinopathy by one surgeon from 2015 to 2019 were studied and divided into 2 cohorts: the control group underwent standard surgery, and the ILM clean group underwent additional cleaning of the macular retina using a flexible nitinol loop after vitrectomy. Masked comparison of ERM on optical coherence tomography was performed at 3 months, and visual acuity (VA) was measured until 12 months postoperatively. Results: Baseline demographics, clinical features, and protein levels were similar between cohorts. The ILM clean group ( n = 56) had fewer clinically significant ERM than the control group ( n = 50; 4 vs. 20%; p = 0.01), and a significantly lower proportion of the ILM clean group required revision surgery (2 vs. 14%; p = 0.02). VA in the ILM clean group was significantly better than in the control group at 3 months (0.35 vs. 0.50 logMAR; p = 0.02) but not at 12 months (0.34 vs. 0.43 logMAR; p = 0.17). Conclusion: ILM cleaning with a flexible nitinol loop following diabetic vitrectomy resulted in significant reduction in ERM formation and reduced necessity for revision surgery. There was significant improvement in VA at 3 months but not over a longer follow-up.

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          Most cited references36

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          Grading Diabetic Retinopathy from Stereoscopic Color Fundus Photographs—An Extension of the Modified Airlie House Classification

          (1991)
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            Treatment Techniques and Clinical Guidelines for Photocoagulation of Diabetic Macular Edema

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              Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment.

              To investigate the feasibility and efficacy of microincision vitrectomy surgery (MIVS) combined with intravitreal bevacizumab (IVB) as a surgical adjunct for treating traction retinal detachment (TRD) secondary to severe proliferative diabetic retinopathy (PDR). Retrospective, comparative, consecutive, interventional case series. Seventy-one eyes of 59 consecutive patients who underwent primary vitrectomy for diabetic TRD and were followed up for more than 6 months after surgery. Eyes that received IVB (1 mg) as a preoperative adjunct followed by MIVS (IVB/MIVS group) from November 2005 through December 2007 were compared with eyes that underwent conventional 20-gauge pars plana vitrectomy (20-g PPV group) from September 2003 through October 2005. Primary and ultimate anatomic success, intraoperative and postoperative complications, and final visual success with at least 6 months of follow-up. This series included 38 eyes (33 patients) in the IVB/MIVS group and 33 eyes (26 patients) in the 20-g PPV group. The primary and ultimate anatomic success rates (95% vs. 91% and 100% in both groups, respectively) and the mean visual acuity changes did not differ significantly between groups; the surgical time and intraoperative bleeding in the IVB/MIVS group decreased significantly compared with the 20-g PPV group (P<0.001). The rate of visual improvement of 3 lines or more at the 6-month follow-up was 68% in the IVB/MIVS group and 49% in the 20-g PPV group, respectively. Progression of the preexisting TRD after IVB occurred in 7 eyes (18%). Absence of previous laser photocoagulation (P = 0.025) and the presence of a ring-shaped fibrovascular membrane (P = 0.013) were relevant findings in eyes with these IVB-induced complications. Intravitreal bevacizumab plus MIVS offers comparable anatomic success compared with conventional 20-gauge PPV in patients with TRD resulting from severe PDR. This technique shortens the surgical time with fewer intraoperative complications and favorable visual recovery. However, caution should be taken because of rapid progression of the preexisting TRD after IVB in some patients. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2020
                December 2020
                03 July 2020
                : 243
                : 6
                : 426-435
                Affiliations
                [_a] aBiosciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
                [_b] bDepartment of Ophthalmology, Sunderland Eye Infirmary, Sunderland, United Kingdom
                [_c] cOcular Angiogenesis Group, Department of Ophthalmology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
                [_d] dFaculty of Health Sciences and Well Being, University of Sunderland, Sunderland, United Kingdom
                Author notes
                *David H. Steel, Department of Ophthalmology, Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland SR2 9HP (UK), david.steel@ncl.ac.uk
                Author information
                https://orcid.org/0000-0003-0578-816X
                Article
                509878 Ophthalmologica 2020;243:426–435
                10.1159/000509878
                32623429
                78aa47b9-6755-4315-a17d-46ea8d905233
                © 2020 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 29 April 2020
                : 22 June 2020
                Page count
                Figures: 2, Tables: 5, Pages: 10
                Categories
                Research Article

                Vision sciences,Ophthalmology & Optometry,Pathology
                Vitreous proteomics,Diabetic vitrectomy,Epiretinal membrane,Internal limiting membrane,Proliferative diabetic retinopathy

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