A long-term follow-up for diabetic retinopathy with diffuse retinal edema and massive subretinal hard exudates / 解放军医学杂志

ABSTRACT

Objective To evaluate the clinical effects of surgical treatment for diabetic retinopathy(DR)with diffuse diabetic retinal edema(DDRE)and massive subretinal hard exudates(MSHE)by vitrectomy,endolaser retinal photocoagulation and long acting gas tamponade via analyzing the long term results.Methods Thirty eyes of twenty five patients with DR with DDRE and MSHE were recruited from October 2001 to December 2006.Among them,17 eyes belonged to 14 male patients and 13 eyes of 11 females.The patients' age was from 36 to 68 years(mean 54.6).The best corrected visual acuity(BCVA),color fundus photography,fundus fluorescein angiography(FFA)and optic coherence tomography(OCT)were performed preoperatively.Pars plana vitrectomy,posterior hyaloid removal,endolaser photocoagulation and long acting gas tamponade were used to treat the affected eyes.Results Preoperative BCVA was finger counting to 0.05 in all the 30 eyes.During 12-23 months of follow up period,2 eyes showed no change in BCVA,vision improvement was observed in 28 eyes(93.3%)with BCVA rising to 0.03-0.04 in 3 eyes,≥0.09 in 25 eyes,and among them the BCVA rose from 0.04 to 1.0 in one eye.The macular retina thickness thinned from preoperative ≥450?m to postoperative 160 220?m,intra-retinal and pre-retinal hemorrhage as well as MSHE was absorbed markedly or completely.Visual acuity decreased in 7 eyes(23.3%)during 24-42 months of follow up,anterior ischemic opticneuropathy occurred in 3 eyes(10%),macular edema recurred in 4 eyes(sub-macular hard exudates appeared in 2 eyes),and macular thickness measured 310-410?m.Scars in sub-fovea and peri-fovea sub-retina were noted in 5 eyes,in which the visual acuity was improved from finger counting to 0.04.Conclusion Vitrectomy,including posterior hyaloid removal,endolaser retinal photocoagulation and long acting gas tamponade may offer satisfactory effects in the treatment for DR complicated with DDME and MSHE.