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Ankur N. Mehta, Michelle J. Ubels, Asheesh Tewari, Tamer H. Mahmoud; Structural and Functional Outcome of Pars Plana Vitrectomy with Internal Limiting Membrane Peel for Refractory Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2011;52(14):993.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the anatomical and functional outcome of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling on refractory DME despite previous therapy.
Retrospective interventional study of patients with refractory DME who have undergone PPV with ILM peeling. Data was collected at baseline, 3, 6 (primary end point), and 12 month post-operative visits. Patient demographics, DME treatment history including macular photocoagulation, intravitreal steroids and/or anti-vascular endothelial growth factor (VEGF), best corrected visual acuity (BCVA), and optical coherence tomography (OCT) central macular thickness was recorded at each visit. Exclusion criteria included any history of DME treatment or peripheral retinal photocoagulation (PRP) within 3 months of surgery and other ocular surgery (including cataract extraction and YAG capsulotomy) within 6 months of surgery.
Eighteen eyes of 15 patients (7 males, 8 females) satisfied the inclusion criteria. Mean age was 64±11.1 years. Average duration of diabetes was 20±7.7 years. At baseline, mean logMAR BCVA was 0.9 (20/175) and mean OCT thickness was 442±118 µm. Seven eyes had been treated with focal laser only, 5 eyes with focal laser and anti-VEGF injections, 1 eye with anti-VEGF injection only, 1 eye with focal laser and intravitreal steroid, and 4 eyes with no prior treatment. During PPV, additional procedures included PRP in 55% and posterior subtenon steroid injection at the close of surgery in 72%. At 6 months, mean OCT thickness decreased to 299±77 µm (p=.0004) and logMAR BCVA improved to 0.7 (20/100, p=0.02). ETDRS BCVA improved by >2 lines in 50%, deteriorated by >2 lines in 22%, and remained stable in 28%. No major surgical complications were observed during the follow-up period.
Some patients may present with refractory DME despite a wide range of currently available treatment options including focal laser, intravitreal steroids, and anti-VEGF agents. PPV with ILM peeling for refractory DME can result in significant improvement in BCVA and reduction of retinal thickness.
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