April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Evaluation of Vitrectomy for Diabetic Macular Edema in Eyes With Vitreomacular Traction
Author Affiliations & Notes
  • J. A. Haller
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • for the Diabetic Retinopathy Clinical Research Network
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • Footnotes
    Commercial Relationships  J.A. Haller, None.
  • Footnotes
    Support  Supported through a cooperative agreement from the National Eye Institute and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 1677. doi:
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      J. A. Haller, for the Diabetic Retinopathy Clinical Research Network; Evaluation of Vitrectomy for Diabetic Macular Edema in Eyes With Vitreomacular Traction. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1677.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To evaluate vitrectomy for diabetic macular edema (DME) in eyes with vitreomacular traction in a prospective cohort study.

Methods: : This prospective cohort study included eyes undergoing vitrectomy without concomitant cataract extraction for DME and: vitreomacular traction, ETDRS visual acuity (VA) Snellen equivalent 20/63-20/400 and optical coherence tomography central subfield (OCT CSF) thickness >300 microns. Surgery was performed according to the investigator’s usual routine. VA, OCT, and photographs were collected at baseline, 3 months, 6 months (primary endpoint), and 1 year, with complication data collected intraoperatively and postoperatively. Main outcomes included: VA, OCT retinal thickening, and surgical complications.

Results: : 241 eyes were enrolled and underwent vitrectomy for DME at 35 clinical sites. Of these, 87 eyes were included in this primary cohort study. At baseline, mean VA was 20/100, mean OCT thickness was 491 microns and 69% of eyes had proliferative diabetic retinopathy. Vitrectomy procedures included epiretinal membrane (ERM) peeling in 61%, internal limiting membrane (ILM) peeling in 54%, panretinal photocoagulation (PRP) in 38%, and use of steroids at the close of the procedure in 64% (66% of these intravitreal). At 6 months, the mean reduction in OCT CSF thickness was 153 microns, with central subfield remaining ≥250 microns in 58%. VA had improved by 10 or more letters in 37%, while 23% lost 10 or more letters and mean VA change was +3 letters. Postoperative complications included vitreous hemorrhage (6), elevated intraocular pressure requiring treatment (7), retinal detachment (3), and endophthalmitis (1).

Conclusions: : In this prospective study of 87 eyes undergoing vitrectomy for DME and associated vitreomacular traction, the mean VA changed little between baseline and 6 months. Reduction in OCT thickness to ≤250 microns was achieved in slightly less than half of this cohort with surgery and commonly performed adjuncts to vitrectomy including: ERM and ILM peeling and use of intraocular and periocular steroids. These data provide a baseline for future studies of vitrectomy for DME.

Clinical Trial: : www.clinicaltrials.gov NCT00709319

Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • vitreoretinal surgery 

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