title: Planned foveal detachment technique for the resolution of diffuse diabetic macular edema.
abstract: OBJECTIVE
  To evaluate the therapeutic efficacy of a novel surgical procedure for diffuse diabetic macular edema (DME), performed in conjunction with conventional vitrectomy.
  
  
  METHODS
  This prospective, interventional case series involved 20 eyes of 18 consecutive DME patients with best-corrected visual acuities (BCVAs) between 0.301 and 1.221 logarithm of the minimal angle of resolution (logMAR) units and central retinal thicknesses (CRTs) greater than 275 μm. After vitrectomy, a small retinal detachment was made in the macula by injecting 50-100 μl balanced salt solution into the subretinal space using a 38-gauge needle. Before finishing the surgery, fluid-air exchange was performed. Patients were asked to remain in prone position for 1 day postoperatively. The main outcome measures were CRT and BCVA.
  
  
  RESULTS
  The mean CRT of 554.6 ± 152.7 μm before surgery significantly decreased to 295.6 ± 92.5 μm (p < 0.0001) 1 week after surgery and to 185.8 ± 67.4 μm (p < 0.0001) at 6 months after surgery. The CRT was less than 250 μm in 18 eyes (90 %) at 6 months after surgery. The mean BCVA before surgery (0.706 ± 0.348) significantly improved at 6 months after surgery (0.431 ± 0.392, p < 0.0001). Postoperative BCVAs improved by more than 0.3 logMAR units in 13 eyes (65 %), remained unchanged in six eyes (30 %) and worsened in one eye (5 %). Macular edema recurred in three eyes (15 %) 2 months after surgery.
  
  
  CONCLUSIONS
  This novel planned foveal detachment technique facilitated a rapid resolution of DME and contributed to improved visual acuity.
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Morizane
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Mio
authors.initials: M
authors.lastname: Hosokawa
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shiode
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hirano
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Doi
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Hosogi
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujiwara
authors.affiliation: Inoue Eye Clinic, 1-14-31 Uno, Tamano City, Okayama, 706-0011, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 7008558, Japan. shiraga@okayama-u.ac.jp.
authors.forename: Fumio
authors.initials: F
authors.lastname: Shiraga
mesh_terms: D000085:Acetates / Q000008:administration & dosage; D000368:Aged; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004338:Drug Combinations; D058450:Endotamponade; D005260:Female; D005584:Fovea Centralis / Q000601:surgery*; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000008:administration & dosage; D016684:Prone Position; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D000085:Acetates; C030660:BSS solution; D004338:Drug Combinations; D008903:Minerals; D012965:Sodium Chloride
keywords: Diffuse diabetic macular edema; Foveal detachment; Vitrectomy