Foveal Hard Exudates Research Articles

Visual Acuity Evaluation in Diabetic Macular Oedema with Foveal Hard Exudates

Visual Acuity Evaluation in Diabetic Macular Oedema with Foveal Hard Exudates

Removal of foveal hard exudates by subretinal balanced salt solution injection using 38-gauge needle in diabetic patients

To examine the anatomic and visual outcomes after removal of foveal hard exudates through a macular hole created by subretinal balanced salt solution (BSS) injection. This was a retrospective, consecutive, case series. Six patients (7 eyes) underwent vitrectomy with removal of foveal hard exudates. All patients were women and the mean age was 65years (range from 55 to 71). All patients had a history of panretinal photocoagulation. Previous treatments included intravitreal anti-vascular endothelial growth factor injection in one eye and vitrectomy in both eyes of one patient. The geometric mean preoperative decimal visual acuity was 0.11 (range from 0.08 to 0.3). The mean postoperative follow-up period was 12months (range from 6 to 19). The status of lens was two phakic and five pseudophakic. Surgical procedures included simultaneous cataract surgery if phakic, creation of posterior vitreous detachment if not present, internal limiting membrane (ILM) peeling and a gas or air tamponade. Manual subretinal BSS injection using 38-gauge needle was performed at ILM-peeled area. Removal of foveal hard exudates was conducted by the water flow through the macular hole created during subretinal BSS injection. Foveal hard exudates decreased in all cases early after surgery. The geometric mean final decimal visual acuity was 0.31 (range from 0.1 to 0.9). Visual acuity improved more than 0.2 LogMAR units in six eyes and unchanged in one eye. There was no severe complication and recurrence of macular edema. This procedure may be effective for foveal hard exudates in diabetic patients.

Effect of Intravitreal Ranibizumab on Intraretinal Hard Exudates in Eyes with Diabetic Macular Edema

To study the effect of monthly 0.3-mg intravitreal ranibizumab injections on intraretinal hard exudates (HEs) and correlate the effect with macular thickness in eyes with diabetic macular edema (DME). Randomized, controlled trial. Twenty-four eyes of 24 subjects with DME were included in this institutional review board-approved, prospective longitudinal study. Subjects were randomly assigned to receive monthly intravitreal ranibizumab injections either until macular edema resolved or until both macular edema and HEs resolved. All subjects underwent spectral-domain optical coherence tomography imaging (Cirrus OCT), at baseline and monthly for 12months. Mean HE area and mean macular thickness at baseline and month 12 were compared using a paired t test and correlated with Pearson analysis. The average age of the 24 subjects was 65 (±8.55) years. There was a significant decrease (P= .001) in mean HE area from baseline (0.48 ± 0.43mm2) to month 12 (0.17 ± 0.19mm2). There was a significant increase (P < .001) in best-corrected visual acuity from a letter score of 63.38 (±7.92) at baseline to 76.38 (±8.93) at month 12. There was no additional vision benefit for continuing to treat with monthly injections for persistent HE in the absence of macular thickening. In eyes with DME, monthly intravitreal ranibizumab injections resulted in significant reduction in intraretinal HEs that paralleled reductions in macular thickness and volume. Baseline foveal HEs were associated with worse vision outcomes, and continued treatment for persistent HEs in the absence of edema did not result in better vision.

Optical Coherence Tomographic Evaluation of Foveal Hard Exudates in Patients with Diabetic Maculopathy Accompanying Macular Detachment

To study morphologic changes of serous retinal detachment (SRD) and hyperreflective dots, which have been reported to be precursors of hard exudates, detectable in SRD using optical coherence tomography (OCT) to assess whether or not the OCT findings are correlated with the subfoveal deposition of hard exudates in patients with diabetic macular edema (DME) accompanied by SRD. Retrospective chart review. Twenty-eight eyes of 19 patients with DME accompanied by SRD. We imaged SRD and the hyperreflective dots in SRD using spectral domain OCT (SD-OCT). The number and distribution of the hyperreflective dots in SRD were evaluated before the initial treatment at our hospital for DME accompanied by SRD. Based on a difference in the SD-OCT findings, the study eyes were divided into 2 groups: eyes with a few dots and those with many dots. We studied the clinical course of these 2 groups to assess whether or not the findings of SRD and hyperreflective dots on the SD-OCT images were correlated with deposition of hard exudates in the subfoveal space during follow-up. Correlation of the SD-OCT findings of SRD and hyperreflective dots with deposition of hard exudates in the subfovea of patients with DME accompanied by SRD. Subfoveal deposition of hard exudates was seen in 11 of the 28 eyes at the final examination. Before initial treatment at our hospital, 14 eyes had a few hyperreflective dots SRD and 14 eyes had many hyperreflective dots. Whereas no deposition of hard exudates in the subfoveal space was seen in the former eyes, it was seen in 11 of the latter 14 eyes (P < 0.0001). In addition, using SD-OCT, we found discontinuity of the outer border of detached neurosensory retina in 9 of the 28 eyes. Of these 9 eyes, 1 was in the group with few hyperreflective dots and eight were in the group with many hyperreflective dots (P = .0046). In patients with DME accompanied by SRD, SD-OCT revealed that hyperreflective dots may be associated with the subfoveal deposition of hard exudates during follow-up.

Secondary macular hole formation with presumed evulsion of foveal hard exudates in a patient with diabetic retinopathy

Secondary macular hole formation with presumed evulsion of foveal hard exudates in a patient with diabetic retinopathy

A Case of Coats' Disease Accompanying A Retinal Macrocyst

Purpose: To report a case of laser photocoagulation treatment for the patient of Coats' disease accompanying a retinal macrocyst. Case summary: A three-year-old boy visited the hospital whose chief complaint was visual acuity decrease of his left eye. Fundus examination showed macular scar, foveal hard exudates and inferior retinal cystic lesion in his left eye. Two months later, examination under anesthesia (EUA) and fluorescein angiography (FAG) was performed. The results revealed inferior retinal macrocyst, nasal avascular retina and telangiectasia around the retinal macrocyst. Laser photocoagulation was performed around the retinal macrocyst and at the nasal avascular retina. One year after the laser photocoagulation, retinal macrocyst did not further progress and the retina was stabilized. Conclusions: Laser photocoagulation was done around the retinal macrocyst and at the nasal avascular retina of the Coats' disease accompanying a retinal macrocyst and the lesions did not further progress and the retina was stabilized.

Long-term results of excision of plaque-like foveal hard exudates in patients with chronic diabetic macular oedema

To analyse the long-term results of surgical removal of plaque-like diabetic foveal hard exudates. In this retrospective, interventional, non-randomized, controlled study, vitrectomy and excision of submacular hard exudates was performed on 11 eyes of 11 patients with plaque-like hard exudates. The mean preoperative LogMAR best corrected visual acuity (BCVA) and exudate diameter were 1.35+/-0.3 and 1.19 disks (range, 0.5-1.8), respectively. In the control group, which consisted of 10 eyes of 7 patients who refused the surgery, baseline mean BCVA and exudate diameter were 1.06+/-0.2 and 1.2 disks (range, 0.7-2.0), respectively. Main outcome measures included BCVA, fundus photography, and surgical complications. The mean follow-up was 39.1+/-3.2 months for the study group and 32.5+/-3.6 months for the control group. In the study group, BCVA improved in 8 (73%) eyes at the final examination. The mean final BCVA was 1.08+/-0.4 (P=0.021). Macular oedema and exudates resolved completely in all eyes. In the control group, final LogMAR visual acuity declined to 1.53+/-0.1 (P=0.005). Macular pigment epithelium atrophy or scar formation was observed in 7 (64%) eyes in the study group and in all eyes in the control group. Surgical excision of plaque-like foveal hard exudates resulted in better anatomical and functional outcome when compared to observation alone.

PRIMARY INTRAVITREAL TRIAMCINOLONE ACETONIDE FOR DIABETIC MASSIVE MACULAR HARD EXUDATES

To evaluate the efficacy of intravitreal triamcinolone acetonide as treatment for massive macular hard exudates in diabetic patients. The study was a prospective, noncomparative, interventional case series of 12 eyes (12 patients) with massive hard exudates involving the fovea that had no previous focal laser treatment. A single intravitreal injection of 4 mg of triamcinolone acetonide in 0.1 mL was performed. Visual acuity and evolution of hard exudates and fluorescein leakage were assessed. Potential complications were monitored, including ocular hypertension and endophthalmitis. The follow-up period ranged from 6 to 12 months (mean, 8.25 months). Visual acuity improved significantly at examinations performed 7 days (P = 0.036), 1 month (P = 0.008), 3 months (P = 0.008), and 6 months (P = 0.003) after the injection. Visual acuity improved by at least 2 Snellen lines in 4 patients (33%). However, no eyes with initial visual acuity worse than 20/100 improved to better than 20/100. Foveal hard exudates resolved completely in 6 eyes (50%) and partially in 6 eyes (50%). Fluorescein leakage decreased and a variable proportion of microaneurysms disappeared in all cases. Intraocular pressure elevation occurred in 3 eyes (25%) and was successfully treated by topical medication. No other complications, such as endophthalmitis, were recorded. Intravitreal injection of triamcinolone acetonide appears to be beneficial for reducing hard exudates, decreasing fluorescein leakage, and significantly improving visual acuity in patients with diabetic massive hard exudates. Visual improvement may not be important due to profound anatomical impairment caused by hard exudate deposition. Further studies with a larger number of patients are required to assess the long-term efficacy and safety and the need for retreatment.

Intravitreal triamcinolone injection for chronic diabetic macular oedema with severe hard exudates

The purpose of the study was to determine the efficacy and safety of intravitreal triamcinolone acetonide (TA) in chronic diabetic macular oedema with severe hard exudates. This prospective, interventional consecutive case series study consisted of 33 eyes of 28 patients with chronic diabetic macular oedema and severe foveal hard exudates who received an intravitreal injection of 4 mg of TA. The patients were divided into two groups according to the type of foveal hard exudates: group I, plaque-like (17 eyes) and group II, dot-like scattered hard exudates (16 eyes). The results of both groups, evaluated by colour fundus photography and fluorescein angiography, were compared and complications were recorded. All patients completed at least 6 months of follow-up. In all eyes, the hard exudates were completely resolved (24% in group I and 50% in group II) or decreased (76% in group I and 50% in group II). In group I, the mean diameter of the exudates plaques significantly decreased from 5.5+/-3.8 mm(2) in the pre-treatment period to 2.2+/-2.7 mm(2) at the end of the follow-up period. There was no recurrence of the hard exudates in either of the groups. The mean +/- SD visual acuity (VA) improved from 0.07+/-2.5 at the baseline to a maximum of 0.09+/-2.1 lines in group I (P<0.01) and from 0.13+/-3.9 to a maximum of 0.27+/-2.7 lines in group II (P<0.01). The mean VA improvement in group II was better than group I (3.2+/-2.5 vs. 1.4+/-1.0 lines, P<0.05). Intraocular pressure exceeded 21 mmHg in 10 eyes (30%), which was then controlled by topical medication. Three eyes (9%) exhibited signs of subcapsular cataract progression. Intravitreal TA appears to be a valuable treatment in chronic diabetic macular oedema with severe foveal hard exudates. In all eyes in this study the hard exudates were completely resolved or decreased, and the mean VA improved significantly in both groups. However, the VA improvement was significantly worse in eyes with plaque-like exudates suggesting the possible value of earlier treatment. Further studies would enable the assessment of the universal effectiveness of this treatment.

Subretinal Washout for Subtle Subfoveal Hard Exudates in Diabetic Macular Edema

To evaluate the efficacy of subretinal washout for subtle subfoveal hard exudates in diabetic macular edema. This study was done retrospectively on a series of patients with diffuse diabetic macular edema accompanied with subtle subfoveal hard exudates and operated on by one surgeon(NO). Patients ranged in age from 30 to 76 years(mean, 59 years). The postoperative follow-up interval ranged from 12 to 76 months, with a mean of 35 months. Two groups were identified. The first group contained all 26 eyes that had vitreous surgery with subretinal washout. This was compared with a second group of 51 eyes without subretinal washout. We compared the rate of occurrence of postoperative massive foveal hard exudates, visual acuity results, and complications with and without subretinal washout. There was no significant difference in base line demographics between the two groups. Massive foveal hard exudates did not occur in eyes with subretinal washout, but occurred in 29 (57%) of the eyes without subretinal washout(p < 0.0001) and in 15 eyes which had undergone reoperation with subretinal washout. Visual acuity improved in 54% of the subretinal washout eyes and 45% of the eyes without it. Visual acuity improved to 20/30 or better in 23% of the eyes with subretinal washout and in 8% of the eyes without subretinal washout. There was no serious complication related to subretinal washout. Subretinal washout for subtle subfoveal hard exudates in diabetic macular edema may prevent massive subfoveal exudates and improve visual results. Further study is needed to investigate the pathogenesis.

The relation between visual acuity, fixation stability, and the size and location of foveal hard exudates after photocoagulation for diabetic maculopathy

To study the relation between changes in visual acuity, fixation stability and the retinal area covered by hard exudates 3, 6 and 12 months after laser photocoagulation for diabetic maculopathy. Twenty-four eyes of 24 patients with diabetes mellitus were examined 3, 6 and 12 months after retinal photocoagulation for clinically significant macular oedema. Each examination included visual acuity testing (ETDRS charts), quantification of fixation stability using a scanning laser ophthalmoscope (Rodenstock 101) and fundus photography. The fundus photographs were digitised and the retinal area covered by hard exudates determined by image processing. The retinal area covered by hard exudates decreased significantly during the first 6 months after treatment ( P=0.05, paired t-test), but increased again between 6 and 12 months after treatment. The visual acuity showed an increase, albeit non-significant, during the first 6 months after treatment followed by a decrease between 6 and 12 months after treatment. Quantification of fixation stability showed that four patients with central exudates fixated at the border of these lesions, and in two of these patients the disappearance of the exudates resulted in increased visual acuity and a change in fixation to the former exudate area. The retinal area covered by hard exudates decreases during the first 6 months after central photocoagulation, but increases again between 6 and 12 months after the treatment. Hard exudates covering the foveal region contribute to disturbance of central vision.

Tomographic findings of foveal hard exudates in diabetic macular edema

PURPOSE: To report the intraretinal location of foveal hard exudates after vitrectomy to treat diabetic macular edema and to evaluate the visual outcome. METHODS: In a prospective study, the tomographic features of 11 eyes (8 patients) with diabetic macular edema were evaluated with optical coherence tomography after vitrectomy. The intraretinal location of hard exudates at the fovea (anatomic foveola) and the relationship with visual acuity were investigated. RESULTS: With optical coherence tomography, hard exudates were observed as highly reflective spots in the cross-sectional images. In six of 11 eyes (54.5%), the hard exudates were in the inner portion of the neurosensory retina; the final best-corrected visual acuity averaged 20/70 in the six eyes. In the remaining five eyes (45.5%), hard exudates were deposited not only in the neurosensory retina but also in the subretinal space. In optical coherence tomographic images, subretinal hard exudates were observed as highly reflective plaques, which were slightly elevated over the retinal pigment epithelium. The five eyes developed a serous retinal detachment at the fovea before or after vitrectomy. Subretinal hard exudates bridged the detached neurosensory retina and the retinal pigment epithelium in two eyes. The average final visual acuity level in the five eyes was 20/300. The visual outcome was significantly worse in five eyes with subretinal hard exudates than in six eyes with an intraretinal one ( P < .05, Wilcoxon rank sum tests). CONCLUSIONS: If serous retinal detachment develops before or after vitrectomy for diabetic macular edema, hard exudates tend to accumulate not only in the neurosensory retina but also in the subretinal space. The visual prognosis is worse in cases of subretinal exudation.

New surgical approach for removing massive foveal hard exudates in diabetic macular edema

Objective To examine the efficacy of surgical removal of foveal hard exudates in diabetic macular edema and to determine the expression of vascular endothelial growth factor (VEGF) in the excised specimens. Design Cohort study. Participants Seven eyes of six patients with massive subfoveal hard exudate due to diabetic macular edema were examined. The average age of the patient was 56 years (range, 46–60 years). Intervention Pars plana vitrectomy for removal of massive foveal exudates was performed. Main outcome measures Preoperative and postoperative visual acuity and complications were recorded; immunohistochemical staining for VEGF and other cell markers for macrophage and pigment epithelial cells in excised specimens was performed. Results Postoperative best-corrected visual acuity improved by two or more lines of Snellen equivalent in five eyes (71%) ( P = 0.0061). VEGF, identified by anticytokeratin and CD68 antibodies, was expressed in pigment epithelial cells and macrophages invading the hard exudates. Conclusion Surgical removal of foveal hard exudates might be effective in low-vision patients with diabetic maculopathy. VEGF might play a role in the formation and persistence of foveal hard exudates in diabetic macular edema.