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F. Kuhn, G. Kiss, R. Morris, V. Mester, Z. Szijarto; Internal limiting membrane removal for clinically significant macular oedema . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4139.
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Purpose: To study the effect of internal limiting membrane (ILM) removal for clinically significant macular edema (CSME). Methods: Retrospective review of 30 consecutive eyes undergoing vitrectomy, ILM peeling, and gas tamponade. Results: The average patient was 52 years old. The edema was caused by diabetes in 87% of the eyes, 42% of which had proliferative disease. The edema was diffuse in 16 eyes (53%) and cystoid (CME) in 14 (47%). In 21% of eyes, spontaneous vitreous detachment was present or the eye had already undergone vitrectomy. All but one eye had at least 6 months of follow–up (average, 12 months). The edema resolved completely in 26 eyes (90%) and partially in 3 (10%). The visual acuity improved at least two Snellen lines in 19 eyes (66%) and one line in four (14%); the average improvement was 4 lines. The acuity was unchanged in three eyes (10%) and worsened in three (10%), all due to cataract. Among the 14 eyes with CME, 11 (79%) became completely dry and the visual acuity improved in 11 eyes (79%). No ILM–related complication was encountered in any eye. Conclusions: Vitrectomy with ILM peeling is a promising approach to eyes with CSME. It appears to offer visual improvement at a much higher rate than laser therapy and with a longer–lasting effect than intravitreal triamcinolones. A larger study is necessary to confirm these preliminary findings.
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