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

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 258; no. 9; pp. 1893 - 1899
• Main Authors: Kumagai, Kazuyuki, Ogino, Nobuchika, Fukami, Marie, Furukawa, Mariko
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2020; Springer Nature B.V
• Subjects: Acuity; Cataracts; Diabetes; Diabetes mellitus; Diabetic retinopathy; Edema; Exudates; Eye; Injection; Medicine; Medicine & Public Health; Ophthalmology; Retinal Disorders; Surgery; Tamponade; Vascular endothelial growth factor; Water flow; Foveal hard exudates; Diabetic retinopathy; Vitrectomy; Diabetic macular edema; 38G cannula
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-020-04756-y

Purpose
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.
Methods
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 65 years (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 12 months (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.
Results
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.
Conclusion
This procedure may be effective for foveal hard exudates in diabetic patients.