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Tomohiro Nizawa, Miyuki Arai, Yoko Takatsuna, Toshiyuki Oshitari, Eiju Sato, Shuichi Yamamoto; Comparison of Visual Acuity and Central Macular Thickness after Vitrectomy for Diffuse Diabetic Macular Edema with or without Preoperative Treatments. Invest. Ophthalmol. Vis. Sci. 2012;53(14):410.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the surgical outcomes with pretreatments to that without pretreatments during 23-gauge pars plana vitrectomy (PPV) for diffuse diabetic macular edema (DME).
The medical charts of 46 eyes of 46 patients who underwent PPV for DME were reviewed. The follow-up period was 6 months. The patients were divided into those who had preoperative treatments (PTs) and those who did not have preoperative treatments (no-PT). The PT group included 20 eyes of 20 patients who were pretreated with intravitreal bevacizumab, sub-Tenon injection of triamcinolone acetonide, and/or subthreshold micropulse diode laser photocoagulation before the PPV. The no-PT group included 26 eyes of 26 patients who underwent PPV alone. The central macular thickness (CMT) measured by OCT and best-corrected visual acuity (BCVA) were measured before and after 1, 3, and 6 months. Statistical analysis was performed with repeated measured ANOVA and P<0.05 was considered significant.
In the PT group, the mean preoperative BCVA was 0.78±0.3 logMAR units, and it was 0.67±0.3 at 1 month, 0.56±0.2 logMAR units at 3 months (P<0.001), and 0.60±0.3 logMAR units at 6 months (P<0.001). The mean preoperative CMT was 540.9±106.4 µm, and it was 426.2±114.2 µm at 1 month (P<0.001), 432.7±151.6 µm at 3 months (P<0.001), and 420.9±152.9 µm at 6 months (P<0.001). In the no-PT group, the mean preoperative VA was 0.77±0.3 logMAR units, and it was 0.68±0.4 logMAR units at 1 month, 0.59±0.4 logMAR units at 3 months (P<0.001), and 0.591±0.376 logMAR units at 6 months (P<0.001). The mean preoperative CMT was 534.4±156.7 µm, and it was 386.8±175.0 µm at 1 month (P<0.001), 354.2±156.4 µm at 3 months (P<0.001), and 334.3±142.5 µm at 6 months (P<0.001). The differences in the BCVA and CMT between PT and non-PT group were not significant.
These results suggest that PPV either with or without preoperative treatments can significantly improve the BCVA and reduce the CMT in patients with diffuse DME. Because the differences in the BCVA and CMT was not significant, PPV may not be the first choice for the treatment of diffuse DME.
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