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S. Degli Esposti, F. Romanelli, A. Polito, M. Sartore, G. Prigione, G. Pertile; Pars Plana Vitrectomy and Inner Limiting Membrane Peeling in Patients With Clinically Significant Diabetic Macular Edema: Long-Term Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3493. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate long term effects (anatomic and functional outcomes) of pars plana vitrectomy (PPV) and inner limiting membrane (ILM) peeling in eyes with diabetic clinically significant macular edema (CSME).
Retrospective, observational case series based on the data of 74 eyes of 52 consecutive patients with CSME and treated with PPV and ILM peeling.Inclusion criteria were one of the following: presence of vitreoretinal interface abnormalities on OCT, large macular hard exudates involving or threatening the foveal centre, macular thickness exceeding 450 microns, CSME unresponsive to other treatments. Eyes were divided into two groups: with vitreoretinal abnormalities (group A; 36 eyes, 49%) and without vitreoretinal interface abnormalities (group B; 38 eyes, 51%).Visual acuity (VA) and Optical Coherence Tomography (OCT III, Zeiss) were performed at baseline and postoperatively during follow up evaluations. Foveal thickness (FT) and total macular volume (TMV) were considered. Follow up ranged from 12 to 48 months (30±18).
Twelve months after treatment VA significantly increased in both groups (P=0,0001). It improved by 3 or more lines in 44 eyes (59,5%; 22 eyes in group A, 22 eyes in group B), remained stable in 20 eyes (27%; 9 eyes in group A, 11 eyes in groupB) and worsened in 10 eyes (13,5%; 4 eyes in group A, 6 eyes in group B).Twentyfour-month follow-up data were available for 45 of 74 eyes (60,8%): VA remained stable in 40 eyes (88,9%; 21 eyes in group A, 19 eyes in group B), and worsened in 5 eyes (11,1%; 3 eyes in group A, 2 eyes in group B).Thirtysix-month follow-up data were available for 33 of 74 eyes (44,6%): VA remained stable in 26 eyes (78,8%; 16 eyes in group A, 10 eyes in group B), and worsened in 6 eyes (18,2%; 4 eyes in group A, 2 eyes in group B).OCT evaluations showed a significant reduction after 12 months ( FT mean decrease 135±164,9, P<0,0001; TMV main decrease 2,2±3 mm3, P<0,0001), and was maintained for the entire follow up, except for 3 eyes (4%) that worsened significantly after 24 months, and needed additional treatments.
In selected patients PPV with ILM peeling leads to significant reduction of CSME and improved VA, even without vitreoretinal abnormalities on OCT. In addiction, OCT FT reduction and visual improvement may persist for up to 36 months in the majority of cases.
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