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S. Yalamanchi, M. M. Lai, S. Greenbaum, G. A. Williams, T. S. Hassan; Long-Term Outcomes of Vitrectomy for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4997.
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To assess the long-term visual and anatomic outcomes of eyes that underwent vitrectomy for treatment of diabetic macular edema.
Medical records of consecutive patients who underwent vitrectomy for diabetic macular edema were retrospectively reviewed. Only patients with greater than 30 months of follow-up were included in the study. Studied variables included Snellen visual acuity, status of macular edema by clinical exam, fluorescein angiographic (FA) findings, macular thickness by optical coherence tomography (OCT), and the need for additional postoperative interventions.
A total of 45 eyes from 38 patients met the inclusion criteria. The mean age was 66 years, duration of symptoms was 17 months, and follow-up was 56 months (range 31 to 94). Thirty-eight eyes (85%) received laser photocoagulation (mean number of treatments = 2) before undergoing vitrectomy. The mean preoperative visual acuity was 20/150, and mean postoperative visual acuity was 20/100. All of the eyes experienced stable or improved vision at some point during their follow-up. At the last follow-up visit, 32 eyes (71%) experienced stable or improved vision and 13 eyes (29%) lost vision. The macular edema resolved in 33 eyes (73%) by postoperative clinical examination, and the mean duration of a non-edematous clinical exam was 51 months. Pre- and post-operative FAs were available for 31 eyes, and 17 eyes (55%) showing improved or resolved macular edema postoperatively. Macular thickness by OCT decreased in 3 of the 4 eyes that had available pre- and post-operative studies. During the follow-up period, 16 eyes (36%) required additional laser photocoagulation, 6 eyes (13%) required intravitreal triamcinolone, and 5 eyes (9%) underwent additional vitrectomy.
Vitrectomy can provide long-term stabilization of visual acuity in patients with chronic, refractory diabetic macular edema. Some patients may continue to lose vision due to recurrent macular edema and require additional interventions postoperatively.
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