Persistent diffuse diabetic macular edema. The role of the internal limiting membrane as a selective membrane: The oncotic theory

• Published in: Medical hypotheses Vol. 76; no. 6; pp. 858 - 860
• Main Author: Saravia, Mario
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.06.2011
• Subjects: Diabetes Complications; Humans; Internal Medicine; Macular Edema - complications; Macular Edema - pathology; Macular Edema - surgery; Models, Theoretical; Vitrectomy
• ISSN: 0306-9877; 1532-2777
• DOI: 10.1016/j.mehy.2011.02.036

Abstract Diabetic macular edema (DME) affects 10% of subjects with diabetes and is the major cause of visual loss. Metabolic control and focal laser can reverse edema in some patients. However, persistent and diffuse diabetic macular edema is usually resistant to these treatments. Since 1992, vitrectomy has been considered for the treatment of some forms of diabetic macular edema. Removal of internal limiting membrane (ILM) has been proposed as a procedure that contributes to improvement of outcomes. Though its efficacy has been debated in some publications, its results seem to be better than those reported with standard laser treatment. The reason of persistence of chronic edema and how this surgery could improve outcomes in these patients remain unknown. The significant role of the ILM in the pathogenesis of persistent diffuse DME might be explained by stressing the importance of colloid and protein accumulation and retention in the retinal interstitial space. A hypothesis is proposed supporting that the ILM has selective permeability by which macular edema is sustained over time.