PURPOSE: To verify the clinical correlation between retinopathy progression and the change of venous filling time (VFT), measured before and after panretinal photocoagulation (PRP), in proliferative diabetic retinopathy (PDR) patients. METHODS: We conducted this study on 32 patients (32 eyes) who received PRP for PDR. These patients were subdivided into two groups in accordance with the clinical course of PRP: the stabilized group in which retinal neovascularization was regressed and the progressed group in which retinal neovascularization was continued and a complication, such as vitreous hemorrhage or tractional retinal detachment, was developed within 12 months of laser treatment. Arteriovenous passage time (AVP) and VFT were measured by video fluorescein angiogram (FAG) using scanning laser ophthalmoscope (SLO) before and after PRP. VFT values were assigned by measuring by the time duration from start of venous lamina flow to the fullness of fluorescence on the vascular arch. RESULTS: In the stabilized group, AVP was decreased by 0.20+/-0.89sec and VFT was decreased by 0.30+/-1.69 sec through PRP. In the progressed group, AVP was increased in 0.12+/-1.22 sec and VFT was increased by 0.99+/-1.60 sec through PRP. In both groups, the VFT changes were significant (P=0.04) but the AVP changes were not (P=0.34). CONCLUSIONS: VFT was significantly decreased in the stabilized group and significantly increased in the progressed group after PRP. Accordingly, we suggest that VFT changes after PRP can be utilized as a prognostic indicator for evaluating clinical course of diabetic retinopathy after performing PRP and for monitoring the clinical effect of PRP.
Veins ; Time Factors ; Retinal Vessels/*physiopathology ; Regional Blood Flow ; *Light Coagulation ; Humans ; Diabetic Retinopathy/*physiopathology/*surgery

PURPOSE: The author evaluated the impact of vitreoretinal surgery for proliferative diabetic retinopathy (PDR) on bilateral visual function. METHODS: Anatomic and visual acuity outcomes were reviewed by author for patients who underwent bilateral surgery for PDR. Bilateral visual function was evaluated using the American Medical Association (AMA) Guidelines for Disability scale to quantitate the impact of surgery on visual system disability. RESULTS: There were 18 patients (36 eyes) who underwent vitrectomy for complications of PDR, and the overall anatomic success rate was 100%. Mean visual impairment of the study eyes and visual system according to AMA Guidelines for Disability decreased postoperatively by 22.4% points, and 25.7% points, respectively. A higher functional level of the bilateral visual system resulted postoperatively in 83.2% of all patients, according to eyes with better visual acuity. CONCLUSIONS: Vitreoretinal surgery was associated with a reduction in bilateral visual disability and improved bilateral visual function in patients with PDR.
American Medical Association ; Diabetic Retinopathy* ; Humans ; Vision Disorders ; Visual Acuity ; Vitrectomy* ; Vitreoretinal Surgery

Aged ; Diabetic Retinopathy ; physiopathology ; surgery ; Electroretinography ; Female ; Humans ; Macular Edema ; physiopathology ; surgery ; Male ; Middle Aged ; Retina ; physiopathology ; Visual Acuity ; Vitrectomy

To analyse the results of diabetic vitrectomy according to the severity of proliferation [severe (SPG) vs. less-severe proliferation group (LSPG)], and methods of the operation, which was complete removal of anteroposterior vitreous traction with or without complete removal of preretinal memebrane, we compared both groups by using anatomic success rate and postoperative visual acuities (VA). The results were as follows: The anatomic success rate and postoperative VA were significantly better in LSPG than in SPG. In SPG, anatomic success rate and postoperative VA tended to be better when complete removal of anteroposterior traction was possible than when impossible. In SPG, postoperative VA tended to be better when complete removal of preretinal membrane was possible, but the anatomic success rate was the same for each group. So, when severe proliferation (including table-top elevation of posterior retina), complete removal of anteroposterior traction only can improve the anatomic success rate of the surgery.
Adult ; Aged ; Cell Membrane ; Diabetic Retinopathy/physiopathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Visual Acuity/physiology ; Vitrectomy/*methods

BACKGROUND: Neovascular glaucoma is common secondary glaucoma at high risk for failure of glaucoma filtering surgery. Recently, trabeculectomy with adjunctive mitomycin C trabeculectomy has been tried to improve the surgical success rate of conventional trabeculectomy. But, the long-term effects of mitomycin C trabeculectomy for neovascular glaucoma are unknown. Thus, we evaluated the long-term effects of mitomycin C trabeculectomy and its prognostic factors influencing the outcome. MATERIALS AND METHODS: Medical records of 62 eyes of 55 neovascular glaucoma who had undergone mitomycin C trabeculectomy were retrospectively reviewed. Surgical success was defined as intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: Postoperative success was obtained in 37 (60%) out of 62 eyes after mean follow- up period of 23.9+/-16.2 months. Using Kaplan-Meier survival analysis, cumulative success rate at the 6-, 12-, 24- and 36-month intervals were 85%, 71%, 57% and 52%, respectively. Success rate was greater in eyes with diabetic retinopathy than other causes(p=0.005) and in eyes with preoperative panretinal photocoagulation(PRP) than without PRP(p=0.015). However, Cox proportional hazard regression analysis revealed that preoperative PRP was not a significant risk factor for surgical failure. CONCLUSION: Prognosis of neovascular glaucoma caused by diabetic retinopathy was better than that caused by the other disorders following mitomycin C trabeculectomy. The author would suggest that mitomycin C trabeculectomy could be effective and relatively safe as the first procedure of choice before performing glaucoma drainage device implantation or cyclodestructive procedure.
Diabetic Retinopathy ; Drainage ; Filtering Surgery ; Glaucoma ; Glaucoma, Neovascular* ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin* ; Prognosis ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.
Bariatric Surgery* ; Diabetes Mellitus ; Diabetic Retinopathy* ; Hemoglobin A, Glycosylated ; Hyperglycemia ; Hypoglycemia ; Life Style ; Obesity ; Population Characteristics ; Retinaldehyde ; Risk Factors

OBJECTIVETo examine the prognosis of preretinal hemorrhage following vitrectomy and silicone oil tamponade for severe proliferative diabetic retinopathy.

METHODSClinical data of 76 cases of proliferative diabetic retinopathy treated with vitrectomy and silicone oil infusion tamponade in Sir Run Run Shaw Hospital from October 2006 to September 2013 were retrospectively reviewed. Intraoperative bleeding,postoperative preretinal bleeding,blood reabsorption time, and preretinal fibrosis were assessed.

RESULTSAll preretinal hemorrhage developed within 1 week after surgery, blood was distributed in thin and scattered patterns (32 cases), thick and localized patterns (25 cases) or thick and scattered patterns (19 cases). The preretinal hemorrhage was ceased in 1 day after operation in 35 cases, in 2 days after operation in 18 cases, in two weeks after operation in 23 case. Recurrent hemorrhage occurred within 1 week after operation in 15 cases. Thin blood was largely reabsorbed in about two weeks, and thick blood was largely reabsorbed in about five weeks. Fibrosis tissue was resulted in 15 cases(34.1%) with thick blood.

CONCLUSIONMost of preretinal hemorrhage occurs within 1 week after surgery and is reabsorpted with 5 weeks in patients with proliferative diabetic retinopathy undergoing vitrectomy and silicone oil tamponade. The major complication of preretinal bleeding is the formation of preretinal fibrosis.

Diabetic Retinopathy ; surgery ; Fibrosis ; Humans ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Silicone Oils ; therapeutic use ; Vitrectomy ; Vitreous Hemorrhage ; epidemiology

Diabetic Retinopathy ; complications ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retinal Vein Occlusion ; complications ; Vitrectomy ; Vitreous Hemorrhage ; etiology ; surgery

PURPOSE: To report the removal of subtenon triamcinolone precipitates in patients with refractory steroid-induced glaucoma following subtenon triamcinolone injection. CASE SUMMARY: A 72-year-old male patient with diabetic retinopathy had cystoid macular edema in the right eye. The patient received a posterior subtenon injection of triamcinolone acetonide and developed intractable glaucoma one month after the injection in the right eye. Corticosteroid-deposit was excised three month after the injection. The intraocular pressure decreased to normal within one month after surgery and remained normal for seven months after surgery. A 42-year-old man with bilateral chronic recurrent anterior uveitis received a posterior subtenon triamcinolone acetonide injection in both eyes. The patient developed refractory steroid-induced glaucoma one month after the injection in the right eye. Corticosteroid-deposit was excised six months after the injection in the right eye. The patient's intraocular pressure decreased to normal within two weeks after surgery and remained normal. Light microscopy showed a fibrous capsule encapsulating an amorphous whitish material. The excised specimen with polarized light showed birefringence of triamcinolone crystals within an encapsulated cyst. CONCLUSIONS: Removal of subtenon triamcinolone acetonide precipitate may facilitate the management of patients developing increased intraocular pressure unresponsive to maximum tolerable medical therapy and should be considered before performing glaucoma filtration surgery.
Adult ; Aged ; Birefringence ; Diabetic Retinopathy ; Eye ; Filtering Surgery ; Glaucoma ; Humans ; Intraocular Pressure ; Light ; Macular Edema ; Male ; Microscopy ; Triamcinolone ; Triamcinolone Acetonide ; Uveitis, Anterior

Changes in retinal sensitivity within central 30 degrees following panretinal photocoagulation (PRP) for more severe diabetic retinopathy were investigated. Twenty-five eyes with visual acuity of 0.4 or better and minimal maculopathy were studied prospectively. All underwent PRP in two sittings, and Humphrey field analyzer 30-2 threshold test was done before and 1 week, 1 and 3 months after the treatment. The mean retinal sensitivity threshold was obtained from each hemifield between 15 and 30 degrees and from the central 15 degree area, and the changes in the values were analyzed. Mean sensitivity threshold in the upper visual field at pre-PRP, post-PRP 1 week, 1, 3 months were 15.62, 13.81, 14.31, 14.85, respectively. Values in the lower field were 18.71, 17.25, 17.10, 18.17. Difference between pre-PRP and post-PRP was statistically significant at 1 week but no longer thereafter. Retinal sensitivity within the central 15 degrees remained stable. The data show that retinal sensitivity decreases significantly 1 week after PRP but recovers upto 95% of pre-PRP level over the following 3 months.
Adult ; Aged ; Diabetic Retinopathy/*physiopathology/surgery ; Female ; Follow-Up Studies ; Humans ; *Laser Coagulation ; Male ; Middle Aged ; Prospective Studies ; Retina/*physiopathology ; Sensory Thresholds ; Visual Acuity/physiology ; Visual Fields/*physiology