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S.J. Garg, A. Sivalingam, A. Martidis; Internal limiting membrane peel for diabetic macular edema refractory to intravitreal kenalog . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4112.
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Purpose: To determine the efficacy of internal limiting membrane peel in patients with clinically significant diabetic macular edema who failed to respond to intravitreal triamcinolone. Methods: We identified six eyes of four patients who had diffuse clinically obtained, these patients underwent pars plana vitrectomy, peeling of the internal limiting membrane, and intraoperative intravitreal triamcinolone significant diabetic macular edema. Prior to surgery, all patients had received intravitreal triamcinolone, with no improvement in visual acuity or in foveal thickness as measured by optical coherence tomography (OCT). No vitreoretinal traction was noted preoperatively. After informed consent was injection. Results: Mean pre–operative visual acuity was 20/400, while mean post–operative visual acuity was 20/80 at an average follow up of 6 months. Foveal contour improved in all patients, and there was an average 65% reduction in macular thickness as measured by OCT (644 µm preoperatively to 220 µm post–operatively). One patient required topical monodrop therapy to control elevated intraocular pressure, and one patient developed neovascular glaucoma secondary to a central retinal vein obstruction 6 months after the surgery. All patients had recurrent edema 4 to 6 months after vitrectomy, and all had excellent response to repeat triamcinolone injection, with improvement in both visual acuity and in foveal thickness. Conclusions: Patients who have clinically significant diabetic macular edema that is refractory to standard focal laser photocoagulation and intravitreal triamcinolone injection may benefit from peeling of the internal limiting membrane with repeat intravitreal triamcinolone injection. Further study is into this novel treatment paradigm is indicated.
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