Zusammenfassung
Hintergrund: Wir analysierten die Befunde und Sehschärfe sowie mögliche Einflussfaktoren nach Vitrektomie bei Patienten mit diabetischem zystoiden Makulaödem. Material und Methoden: In einer prospektiven Studie wurde eine Pars-plana-Vitrektomie bei 62 Patienten mit einem diabetischen zystoiden Makulaödem und insgesamt 72 Augen durchgeführt, bei denen eine Laserkoagulation erfolglos geblieben war. Eine vitreomakuläre Traktion fand sich biomikroskopisch, mittels eines B-Scan-Ultraschalls sowie mittels der optischen Kohärenz-Tomographie bei 21 Augen, 15 Augen wiesen eine komplette hintere Glaskörperabhebung (PVD) auf und 36 Augen eine partielle periphere PVD. Es wurde eine Vitrektomie mit vitreomakulären tangentiellen Auflockerungen und axialen Traktionskräften durchgeführt. Alle Patienten wurden mindestens 6 Monate lang nachbeobachtet. Ergebnisse: Die anatomischen Ergebnisse waren bei 69 von 72 Augen zufriedenstellend (96 %), der postoperative Visus verbesserte sich um zwei und mehr Zeilen bei 45 von 72 Augen (63 %), blieb gleich bei 22 von 72 Augen (31 %) und verschlechterte sich bei 5 von 72 Augen (7 %). Die Verschlechterung war bedingt durch ein zystoides Makulaödem sowie durch extrem große harte Makulaexsudate. Die besten Ergebnisse wurden beim Ödem mit überwiegend traktionellem Charakter beobachtet sowie bei Augen mit einem zystoiden Makulaödem von weniger als 6 Monaten Dauer. Schlussfolgerungen: Die Vitrektomie zur Behandlung des diabetischen zystoiden Makulaödems ist eine effektive Methode, um das Ödem zu reduzieren und um die Sehschärfe zu verbessern. Die Operation war von Nutzen nicht nur bei Augen mit vitreomakulärer Traktion, sondern auch bei Augen mit kompletter PVD. Die Verbesserung der Sehschärfe nach einer Vitrektomie hängt von der Ödemdauer ab, wobei der Operationszeitpunkt den entscheidenden prognostischen Faktor darstellt.
Abstract
Background: We evaluated visual outcomes after vitrectomy for diabetic cystoid macular edema and factors possibly influencing final visual acuity. Materials and Methods: Studied prospectively, pars plana vitrectomy was performed on 72 consecutive eyes of 61 patients with diabetic cystoid macular edema not responsive to laser photocoagulation therapy. Vitreomacular traction was observed on biomicroscopy, B-scan ultrasonography, and optical coherence tomography in 21 eyes, 15 eyes had a complete posterior vitreous detachment (PVD) and 36 eyes had partial peripheral PVD. Vitrectomy with releasing vitreomacular tangential and axial tractional forces was performed. All patients were followed up for at least 6 months. Results: The anatomical results were satisfactory in 69 of 72 eyes (96 %), the final visual acuity improved by 2 or more lines in 45 of 72 eyes (63 %), remained unchanged in 22 of 72 eyes (31 %), and deteriorated after surgery in 5 of 72 eyes (7 %), due to residual cystoid macular edema and massive macular hard exudates. The best results were obtained in edema with tractional predominance and in eyes with a duration of cystoid macular edema shorter than 6 months. Conclusions: Vitrectomy for diabetic cystoid macular edema is an effective procedure for reducing the edema and improving visual acuity. Surgery was beneficial not only in eyes with vitreomacular traction but also in eyes with complete PVD. Visual improvement after vitrectomy is related to duration of edema, therefore the timing of the surgery is an important prognostic factor.
Schlüsselwörter
Diabetisches Makulaödem - makulare Laserkoagulation - Pars-plana-Vitrektomie
Key words
Diabetic macular edema - macular laser photocoagulation - pars plana vitrectomy
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