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C. C. Patel, J. Apple, C. N. Singh, A. Tewari; Outcomes of 23 Gauge Vitrectomy with Internal Limiting Membrane Peel for Recalcitrant Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4209.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the outcomes of patients treated with 23 gauge pars plana vitrectomy and internal limiting membrane peel (ILM) for recalcitrant diabetic macular edema.
A retrospective chart review was performed on 18 consecutive vitrectomy cases done by a single vitreoretinal surgeon for primary indication of diabetic macular edema. All patients had failed conventional treatment with focal laser photocoagulation. Surgery was performed using the 23 gauge system with triamcinolone-assisted ILM peel. Patients with less than one month follow-up were excluded. Preoperative visual acuity, lens status, and best corrected visual acuity at most recent follow-up were recorded. Any interventions performed in the post-operative period, including cataract extraction and intravitreal injections, were also noted. As best possible, preoperative and postoperative OCT was performed to evaluate macular thickness and hyaloidal attachment.
The study included 18 eyes of 17 patients. There were 14 males (78%) and 4 females (22%). Mean age was 57.5 years (range 29 to 71 years). Thirteen eyes (72%) were phakic at time of surgery, 5 eyes (28%) were pseudophakic. Mean follow-up was 97 days (range 30 to 274 days). Mean preoperative visual acuity was 20/503 and improved to 20/270 at final post-operative visit (p=0.176). Eight eyes (44%) gained 3 or more lines of Snellen visual acuity, while 2 eyes (11%) lost more than 3 lines. No eyes underwent cataract extraction during the follow up period, although cataract progression was noted in the majority of phakic eyes. There were no complications, such as postoperative macular hole development or retinal detachment.
Twenty-three gauge vitrectomy with ILM peel is an effective surgical technique in the management of recalcitrant diabetic macular edema. Although longer follow-up may be necessary, the results compare favorably with published literature.
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