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Paola Salvetti, Luigi Bonavia, Ferdinando Bottoni, Stefano de Angelis, Roberta Secondi, Matteo Cereda, Giovanni Staurenghi; ILM peeling in non tractional diabetic macular edema not responsive to standard treatment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2414.
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to evaluate the effect of 25 G pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in diabetic patients with clinicallly significant macular edema without evidence of vitreomacular traction and not responsive to standard therapies.
retrospective analysis of visual acuity (VA), SD-OCT (HRA+OCT Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany ) and fluorescein angiography (FA) images of 15 eyes of 15 vitrectomized patients with diagnosis of diffuse diabetic macular edema. Each patient had been already submitted to intravitreal Bevacizumab and/or posterior pole laser treatment with poor functional and anatomical outcomes. Exclusion criteria included IS/OS defects, subfoveal atrophy and evident vitreomacular traction before vitrecotmy. Combined cataract surgery and 25 G pars plana vitrectomy with indocyanine green assisted ILM peeling were performed in each case by 3 different surgeons (FB, MC, SdeA). Selective Argon laser on peripheral residual ischaemic areas was performed during surgery. Main outcome measures were mean changes in visual acuity (VA) and central retinal thickness (CRT) at 1, 3 and 6 months postoperatively.
7 patients have 6 month-follow-up and 8 patients 3 month-follow-up. No major complications occurred during and after surgeries. Preoperative mean VA was 0,25 +- 0,2 SD (range, 0,05 - 0,625). Postoperative mean VA was 0,42 +-0,31 SD at 1 month follow-up (Paired T-test, P=0,11), 0,39 +-0,24 SD at 3 months (P=0,10) and 0,47 +-0,23 SD at 6 months (P=0,01). VA improved significantly only 6 months after surgery. Mean preoperative CRT was 595,5 +- 188,5 SD microns (range, 391 - 789 microns). Mean CRT at 1 month was 437 +- 143 SD microns (P=0,0004), at 3 months 387 +-130 SD (P=0,000008) and 323 +-152 SD microns at 6 months (P=0,000045). CRT decreased significantly at 1, 3 and 6 months of follow-up (Paired t-Test P<0,01).
PPV with ILM peeling seems to be effective in diabetic patients with clinically significant diffuse macular edema unresponsive to standard care for reducing retinal thickness and improving visual acuity.
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