Proliferative Diabetic Retinopathy Clinical Trial
Official title:
Macular Tractional Retinoschisis in Proliferative Diabetic Retinopathy
Objective: To evaluate the clinical manifestations and surgical prognosis of macular
tractional retinoschisis in proliferative diabetic retinopathy.
Design: Retrospective case series. Participants: Cases with macular tractional retinoschisis
with or without combined traction detachment (TRD) in proliferative diabetic retinopathy
confirmed by optical coherence tomography (OCT) at a single institution between January 2007
and August 2010.
Methods: Cases were divided into two groups. Group A had tractional retinoschisis only while
Group B had TRD with retinoschisis of the elevated retina. Clinical data including OCT
findings were recorded and analyzed.
Main Outcome Measures: Demographic data, clinical pictures, surgical results, and OCT
findings will be compared between two the groups.
Fibrovascular tissue induced macular elevation is an important cause of visual loss in
proliferative diabetic retinopathy (PDR). There are two main types of macular elevations in
PDR: traction retinal detachment (TRD) and tractional retinoschisis. These two conditions
may coexist either in the form of retinoschisis within the detached retina or predominantly
retinoschisis with a small subfoveal fluid pocket. Optical coherence tomography (OCT)
studies have shown that in tractional retinoschisis, the inner retinal layer is normal
reflective; outer layer is less reflective but not optically empty. Bridging columnar
tissues are frequently observed between the inner and outer layers. Histopathological study
by Faulborn et al showed adherence of posterior hyaloid membrane to the retina plus vitreous
body shrinkage might induce retinal elevation with splitting of the outer plexiform layer,
leading to retinoschisis. The bridging columnar tissues between inner and outer layers of
the split retina mainly consisted of Muller cells. Although tractional retinoschisis with or
without retinal detachment has been suggested as the most frequent pattern of tractional
macular elevation in eyes with proliferative diabetic retinopathy1, and peripheral
retinoschisis are frequently found during operation for complications of PDR, studies on
clinical manifestations and post-operative visual prognosis of macular traction schisis are
limited. Lincoff reported a relatively good prognosis in eyes with tractional retinoschisis
after vitrectomy. No other large series specifically aimed at this entity can be found.
In this report, we will retrospectively study the clinical pictures of tractional
retinoschisis on the macula. Morphological changes and functional outcomes after surgery
will be discussed. Correlations between visual acuity and specific findings on color fundus
pictures and OCT will be evaluated. We will also analyze different behaviors of schisis only
and combined tractional retinal detachment with schisis.
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Observational Model: Case-Only, Time Perspective: Retrospective
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