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J. A. Haller, for the Diabetic Retinopathy Clinical Research Network; Evaluation of Vitrectomy for Diabetic Macular Edema in Eyes With Vitreomacular Traction. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1677.
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To evaluate vitrectomy for diabetic macular edema (DME) in eyes with vitreomacular traction in a prospective cohort study.
This prospective cohort study included eyes undergoing vitrectomy without concomitant cataract extraction for DME and: vitreomacular traction, ETDRS visual acuity (VA) Snellen equivalent 20/63-20/400 and optical coherence tomography central subfield (OCT CSF) thickness >300 microns. Surgery was performed according to the investigator’s usual routine. VA, OCT, and photographs were collected at baseline, 3 months, 6 months (primary endpoint), and 1 year, with complication data collected intraoperatively and postoperatively. Main outcomes included: VA, OCT retinal thickening, and surgical complications.
241 eyes were enrolled and underwent vitrectomy for DME at 35 clinical sites. Of these, 87 eyes were included in this primary cohort study. At baseline, mean VA was 20/100, mean OCT thickness was 491 microns and 69% of eyes had proliferative diabetic retinopathy. Vitrectomy procedures included epiretinal membrane (ERM) peeling in 61%, internal limiting membrane (ILM) peeling in 54%, panretinal photocoagulation (PRP) in 38%, and use of steroids at the close of the procedure in 64% (66% of these intravitreal). At 6 months, the mean reduction in OCT CSF thickness was 153 microns, with central subfield remaining ≥250 microns in 58%. VA had improved by 10 or more letters in 37%, while 23% lost 10 or more letters and mean VA change was +3 letters. Postoperative complications included vitreous hemorrhage (6), elevated intraocular pressure requiring treatment (7), retinal detachment (3), and endophthalmitis (1).
In this prospective study of 87 eyes undergoing vitrectomy for DME and associated vitreomacular traction, the mean VA changed little between baseline and 6 months. Reduction in OCT thickness to ≤250 microns was achieved in slightly less than half of this cohort with surgery and commonly performed adjuncts to vitrectomy including: ERM and ILM peeling and use of intraocular and periocular steroids. These data provide a baseline for future studies of vitrectomy for DME.
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