11/372. Electron immunocytochemical analysis of posterior hyaloid associated with diabetic macular edema. BACKGROUND: Tangential traction in the macula from a thickened posterior hyaloid of the vitreous has been implicated as a cause of diffuse diabetic macular edema. vitrectomy with peeling of the posterior hyaloid has been shown to reduce retinovascular leakage and improve vision in select patients. We report a clinicopathologic correlation using electron microscopy and electron immunocytochemistry to characterize the membrane infiltrating the posterior hyaloid in two such patients. methods: Two patients presented with vision loss associated with diffuse diabetic macular edema and an attached, thickened, and taut posterior hyaloid. The patients underwent vitrectomy with peeling of the posterior hyaloid. The premacular posterior hyaloid specimens then were analyzed by electron microscopy with immunocytochemical staining for cytokeratin and glial fibrillary acidic protein. RESULTS: Both posterior hyaloid specimens contained collagen and a large cellular component. Immunogold labeling showed cells positive for glial fibrillary acidic protein or cytokeratin. With double labeling, no cells expressed both proteins simultaneously. Clinically, both patients had vision improvement and macular edema resolution after surgery. CONCLUSIONS: The thickened, taut posterior hyaloid observed in our patients with diabetic macular edema contained cells of glial and epithelial origin. This cellular infiltration may contribute to abnormal vitreomacular adherence and could play a role in the pathogenesis of macular edema in some patients with diabetes. ( info) |
12/372. Improved retinal capillary perfusion following treatment of severe proliferative diabetic retinopathy. The authors report a photodocumented case of improved retinal capillary perfusion accompanied by visual acuity improvement after treatment of severe proliferative diabetic retinopathy. ( info) |
13/372. Difficult therapeutic decisions in the management of diabetic retinopathy. Management decisions for patients with diabetic eye disease can remain difficult despite the presence of guidelines. The cases below illustrate the dilemmas about the timing of instituting insulin in patients needing laser photocoagulation for improvement of glycaemic control. The use of angiotensin-converting enzyme inhibitors for diabetic eye disease is also discussed. ( info) |
| The gastrointestinal motility stimulants, cisapride and erythromycin, have been used in the management of diabetic gastroparesis. However, drug interactions may result in prolongation of the electrocardiographic QT interval with the risk of ventricular arrhythmias. These drugs should, therefore, not be used in combination. We report two cases that illustrate inappropriate use of these agents. Moreover, patients with recurrent severe hypoglycemia or renal impairment may be at increased risk from cisapride-related cardiotoxicity. Thus, even as monotherapy, cisapride may pose dangers for high-risk diabetic patients. ( info) |
15/372. Surgical treatment for severe diabetic macular edema with massive hard exudates. PURPOSE: Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation. methods: The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded. RESULTS: All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye). CONCLUSION: Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema. ( info) |
16/372. Macular oedema with associated uveitis and cataract following presentation of Type 1 diabetes mellitus in severe ketoacidosis. We present a case of cystoid macular oedema presenting in a newly diagnosed diabetic teenager. She had developed anterior uveitis prior to diabetes and whether this contributed to the subsequent ocular complications remains speculative. The macular changes resolved spontaneously over 6 months without the use of grid laser photocoagulation. ( info) |
17/372. Optical coherence tomography after laser photocoagulation for clinically significant macular edema. BACKGROUND AND OBJECTIVE: To demonstrate the utility of optical coherence tomography (OCT) for documenting an early response to laser photocoagulation in clinically significant macular edema (CSME) secondary to diabetes. patients AND methods: Five eyes of four patients were selected for review based on the diagnosis of CSME. All eyes had a clinical diagnosis of CSME based on slit lamp biomicroscopy. All eyes underwent focal/grid laser photocoagulation to areas of retinal thickening detected by OCT and clinical exam. Pre and post-treatment optical coherence tomograms were obtained for all patients. RESULTS: All eyes selected for review had an early positive response to focal laser photocoagulation. OCT was useful for demonstrating areas of retinal thickening prior to laser treatment. Serial macular maps demonstrated the resolution of retinal thickening after laser photocoagulation in all eyes. CONCLUSION: OCT is a useful tool for evaluating and documenting CSME both before and after focal/grid laser photocoagulation. OCT is capable of detecting an early positive response to photocoagulation for macular edema. ( info) |
18/372. Ultrasound biomicroscopy in a case of anterior hyaloidal fibrovascular proliferation. The authors describe the use of ultrasound biomicroscopy for the diagnosis and preoperative evaluation of anterior hyaloidal fibrovascular proliferation (AHFVP). Ultrasound biomicroscopy was performed on a 62-year-old man who presented after diabetic vitrectomy with a hyphema, vitreous hemorrhage, and hypotony. Images in the temporal and nasal meridians revealed thickened tissue bands extending from the peripheral retina to the ciliary body, and from the pars plicata to the posterior surface of the iris. A ciliary body epithelium detachment was seen in the nasal meridian. Ultrasound biomicroscopy demonstrated to be a potential tool in the diagnosis and surgical management of AHFVP. ( info) |
19/372. qi-promoting and phlegm-resolving method for treatment of diabetic microvascular complications. OBJECTIVE: To evaluate the effects of qi-promoting and phlegm-resolving approach in treatment of diabetic microvascular complications. METHODOLOGY: Clinical observation of cases given modified Wen Dan Tang ([symbol: see text] gallbladder-warming Decoction). RESULT: Favorable results obtained in cases of diabetic microvascular complications of the type of stagnancy of qi and phlegm (diabetic retinopathy, diabetic nephropathy and diabetic foot). CONCLUSION: Wen Dan Tang is effective for diabetic microvascular complications of the type of stagnancy of qi and phlegm. ( info) |
20/372. Rapid onset retinopathy in a diabetic patient following bone marrow transplantation. We report a 38-year-old man who presented in 1998 with advanced multiple myeloma and newly diagnosed diabetes mellitus (DM). Subsequent BMT has been successful after conditioning with melphalan and total body irradiation, but significant ischaemic retinopathy has developed. Chemotherapeutic agents, total body irradiation, and DM are likely to have been co-factors in precipitating the rapid onset of retinopathy. Routine ophthalmic surveillance is recommended for all patients after BMT, particularly for those with additional risk factors for the development of retinopathy such as DM. ( info) |