• History of PPV

• Combined rhegmatogenous retinal detachment

• Neovascular glaucoma after PPV

• Silicone oil in the vitreous cavity longer than 6 months

• Who cannot have OCT examination before and after PPV

• Patients who had PPV due to PDR and who had OCT

examination before and after PPV

Clinical Characteristics of the Patients at Baseline (n=60)

Age (years, mean ± SD) 52.4 ± 11.6

Sex (male : female) 30 : 26

Eye (od : os) 28 : 32

Pre-operative BCVA (logMAR, mean ± SD) 1.10 ± 0.83

PRP status before PPV (none : partial : full) 8 : 3 : 49

Lens status before PPV (phakic : pseudophakic) 50 : 10

Changes in Macular Appearance in OCT after Diabetic VitrectomyJae Pil Shin, M.D.1, Woo Hyuk Chang, M.D.2, Si Dong Kim, M.D.3, Si Yeol Kim, M.D.4

1Department of Ophthalmology, Kyungpook National University Hospital,2Department of Ophthalmology, Youngnam University Hospital

3Department of Ophthalmology, Daegu Catholic Hospital, 4Nune Eye Hospital, Daegu, Korea

To classify the structural change of macula with optical

coherence tomography (OCT) and to analyze visual

prognosis according to the appearance of macula in OCT

after pars plana vitrectomy (PPV) in proliferative diabetic

retinopathy (PDR)

Results

Conclusions

Exclusion criteria

Inclusion criteria

Most common OCT findings after vitrectomy in PDR are normal

fovea (28.3%), ERM (21.7%) and macular thickening (15%). Visual

prognosis is correlated with OCT findings of macula after diabetic

vitrectomy. Good visual outcomes were found when postoperative

OCT shows normal, ERM, and edema outside of fovea. Moderate

visual outcomes were found in macular thickening, macular cystic

change, and subfoveal HE. Poor visual oucomes were found in

subfoveal fibrosis, macular hole, loss of fovea depression, and

serous foveal detachment.

a. Normal fovea without

macular traction

b. Normal fovea with

macular traction

c. Normal fovea with

preretinal hemorrhage

d. Tractional retinal detachment

(TRD) involving fovea

e. Cystoid macular edema (CME)

with epiretinal membrane

f. Vitreomacular traction

syndrome (VMT)

OCT classification before PPV

OCT classification after PPV

a. Normal

b. Epiretinal membrane (ERM)

c. Macular thickening

(CMT>300μm)

d. Macular cystic change

e. Edema outside of fovea

f. Loss of foveal depression

g. Subfoveal hard exudates

h. Subfoveal fibrosis

i. Macular hole / lamellar hole

j. Serous foveal detachment

Changes of BCVA and macular appearance in OCT after PPV

Preoperative OCT

findingsNo.

BCVA (logMAR, mean ± SD)

Pre-op Post-op p-value *

Normal fovea with or

without macular traction20 0.86 ± 0.70 0.32 ± 0.33 0.003

Normal fovea with

preretinal hemorrhage17 1.36 ± 0.95 0.44 ± 0.49 0.002

TRD involving fovea 8 1.59 ± 1.07 0.51 ± 0.32 0.018

CME with ERM 8 0.87 ± 0.60 0.51 ± 0.35 0.166

VMT 7 0.90 ± 0.40 0.63 ± 0.24 0.126

* Paired T-test

Frequency of macular appearance in OCT after PPV

ERM: epiretinal membrane, MT: macular thickening, MC: macular cystic change,SF: subfoveal fibrosis, EOF: edema outside the fovea,HE: subfoveal hard exudates, LFD: loss of foveal depression,MH/LH: macular hole/lamellar hole, SFD: serous foveal detachment

Patients

No. (%

)

Postoperative macular appearance

Postoperative macular appearance in OCT

Post

opera

tive

BCVA (lo

gM

AR)

Visual prognosis after PPV according to post-operative OCT findings

Good prognosis Moderate prognosis Poor prognosis

Changes of BCVA according to postoperative OCT findings

Postoperative OCT

findingsNo. (%)

BCVA (logMAR, mean ± SD)

Pre-op Post-op p-value *

Normal 17 (28.3) 0.94 ± 0.82 0.11 ± 0.18 0.001

Epiretinal membrane 13 (21.7) 0.82 ± 0.61 0.33 ± 0.33 0.025

Macular thickening 9 (15.0) 1.11 ± 0.83 0.64 ± 0.42 0.240

Macular cystic change 5 (8.3) 1.73 ± 0.95 0.64 ± 0.31 0.188

Edema outside of fovea 3 (5.0) 1.73 ± 1.20 0.36 ± 0.15 0.175

Loss of foveal depression 2 (3.3) 1.80 ± 0.90 0.90 ± 0.57 0.460

Subfoveal hard exudates 3 (5.0) 1.47 ± 0.33 0.60 ± 0.20 0.379

Subfoveal fibrosis 5 (8.3) 0.98 ± 0.25 0.76 ± 0.14 0.086

Macular hole/lamellar hole 2 (3.3) 0.80 ± 0.28 0.85 ± 0.08 0.795

Serous foveal detachment 1 (1.7) 1.3 1 -

* Paired T-test

Purpose

Patients and Methods

Retrospective study

From Jan 2012 to Dec 2013

Preoperative OCT

findings (n)

Postoperative

OCT findings n (%)

BCVA (logMAR, mean ± SD)

Pre-op Post-op p-value *

Normal fovea with

or without macular

traction (20)

NL

ERM

EOF

MT

SF

8 (40)

7 (35)

3 (15)

1 (5)

1 (5)

0.74 ± 0.6

0.63 ± 0.41

1.73 ± 1.20

0.49

1.00

0.13 ± 0.24

0.43 ± 0.42

0.36 ± 0.15

0.49

0.70

0.039

0.028

0.018

Normal fovea

with preretinal

hemorrhage (17)

NL

ERM

MT

HE

LFD

MH/LH

7 (41.2)

2 (11.8)

5 (29.4)

1 (5.9)

1 (5.9)

1 (5.9)

1.34 ± 1.00

1.35 ± 0.92

0.88 ± 0.40

0.60

1.30

0.80

0.06 ± 0.09

0.20

0.78 ± 0.53

0.60

1.30

0.80

0.016

0.032

0.792

TRD involving fovea

(8)

NL

ERM

MT

MC

1 (12.5)

2 (25)

1 (12.5)

4 (50)

0.30

0.65 ± 0.21

3.00

2.03 ± 0.77

0.30

0.31 ± 0.30

0.52

0.65 ± 0.35

0.117

0.054

CME with ERM (8)

NL

ERM

MC

SF

LFD

SFD

1 (12.5)

2 (25)

1 (12.5)

2 (25)

1 (12.5)

1 (12.5)

0.10

1.15 ± 1.20

0.60

0.95 ± 0.49

0.49

1.00

0.10

0.45 ± 0.35

0.60

0.75 ± 0.21

0.49

1.00

0.451

0.500

VMT (7)

MT

SF

HE

MH/LH

2 (28.6)

2 (28.6)

2 (28.6)

1 (14.3)

0.95 ± 0.92

1.00

0.70

0.90

0.40 ± 0.14

0.75 ± 0.21

0.60 ± 0.28

0.90

0.500

0.348

0.698

Changes of BCVA according to preoperative OCT findings

NL: normal fovea, ERM: epiretinal membrane, MT: macular thickening, MC: macular cysticchange, SF: subfoveal fibrosis, EOF: edema outside of fovea, HE: subfoveal hard exudates, LFD:loss of foveal depression, MH/LH: macular hole/lamellar hole, SFD: serous foveal detachment,* Paired T-test