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Tatjana Josifova, Bernhard P. Henrich; Results of ILM peeling and Anti-VEGF Drug Administration in Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2011;52(14):989.
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The purpose of this study is to compare the effectiveness of pars plana vitrectomy (PPV) and peeling of the internal limiting membrane (ILM) with or without Anti-VEGF drug administration, and Anti-VEGF therapy alone, in patients with diabetic macular edema (DME).
48 eyes of 40 patients with metabolically stable diabetes and persistent cystoid DME were evaluated. The patients were randomized to either ppv with removal of ILM performed in 19 eyes (ILM group), combined ILM removal + intravitreal Anit-VEGF drug administration, carried out in 15 eyes (ILM+ Anti-VEGF group), and Anti-VEGF drug administration alone in 14 patients. 20 and 23 G. ICG assisted ppv was performed. Bevazizumab (Avastin) administration was in 0,05ml/1,25 mg, intravitreal. The follow-up period was nine months. Visual acuity (VA) and OCT, central foveal thickness (CFT) investigations were done preoperatively and were repeated every 6 weeks. After six months more then 100 µm CFT increase in both groups with Anti-VEGF drug administration was indication for repeated medication.
Six weeks after surgery in ILM+Anti-VEGF group decrease in CFT was detected in 69% , 64% in Anti-VEGF Group, versus ILM group with 58%. 6 months CFT investigation results: 62% (ILM+ Anti-VEGF group), 61% in the Anti_VEGF Group and 55% ILM group. Nine months results: 62% in the ILM+ Anti-VEGF Group, 58% in the Anti-VEGF Group, and 51% in the ILM Group. CFT increase after 6 months follow-up period was present with 5% in ILM + Anti-VEGF , 6,5% in the ILM group and 5,7% in the Anti-VEGF group. After 6 weeks VA improvement was seen in 38% in the ILM+Anti-VEGF group, ILM group with 29% and 33,3% in the Anti_VEGF group. Six months follow-up VA improvement was present in 42% in the ILM+Anti-VEGF group, 37% in the ILM group compared to Anti-VEGF group with 41,2%. Nine month VA improvement results: 39,6% in the ILM+Anti-VEGF group, 33% in the ILM group compared to Anti-VEGF group with 39,3%.
CFT reduction outcome showed better results in both groups with Anti-VEGF drug administration compared to ILM peeling alone. ILM peeling and Anti-VEGF administration, as well as drug administration alone is beneficial in VA outcome, compared to only ILM peeling alone. Six weeks follow-up results are better then nine months follow-up results. ILM Peeling alone is not beneficial in the treatment of DME.
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