Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema

• Published in: American journal of ophthalmology Vol. 139; no. 3; pp. 447 - 454
• Main Authors: Recchia, Franco M., Ruby, Alan J., Carvalho Recchia, Cynthia A.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2005; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Basement Membrane - surgery; Biological and medical sciences; Diabetes; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - surgery; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epiretinal Membrane - surgery; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Laser Coagulation; Lasers; Macular degeneration; Macular Edema - diagnosis; Macular Edema - surgery; Male; Medical sciences; Middle Aged; Pharmaceutical industry; Prognosis; Prospective Studies; Quality of life; Tomography, Optical Coherence; Visual Acuity; Visual impairment; Vitrectomy; Endocrinopathy; Removal; Macula; Edema; Pars plana; Treatment; Exeresis; Surgery; Diabetes mellitus; Vitrectomy; Ophthalmology; Internal membrane
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2004.09.076

To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edema refractory to laser photocoagulation. Prospective, consecutive, interventional case series. Diabetic patients with biomicroscopic, angiographic, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for inclusion. Patients with biomicroscopic evidence of epiretinal membrane or taut posterior hyaloid, previous vitreoretinal surgery, or active proliferative diabetic retinopathy were excluded. The main outcome measures were macular thickness, as measured by optical coherence tomography (OCT) and visual acuity (VA). PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six women; mean age = 58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20% in eight of 11 eyes (mean preoperative thickness of 421 μm compared with mean postoperative thickness of 188 μm; P = .007). Mean VA improved from 20/352 to 20/94 at 6 months ( P = .002). By the most recent visit (range = 6–20 months postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in some eyes with chronic diabetic macular edema unresponsive or unamenable to additional laser photocoagulation.