Minimal Central Vitrectomy by TSV 25 G and Intravitreal Triamcinolone Acetonide With or Without Inner Limiting Membrane Removal in Diabetic Diffuse Macular Edema Treatment

Abstract

Abstract: : Purpose: To determine whether Vitrectomy 25 Gauge and Intravitreal Injection of Triamcinolone with or without internal limiting membrane (ILM) peeling reduces diffuse diabetic macular thickening and edema. Methods: We analyzed the surgical outcomes in 10 eyes of 6 patients with diffuse diabetic macular edema who underwent minimal vitrectomy and intravitreal triamcinolone (4mg). Four eyes (Group A, medium macular thickness 720 ±20 micron) underwent three–port pars plana Transconjunctival Sutureless Vitrectomy 25 Gauge (TSV 25 G) with posterior hyaloid membrane (PHM) removal. Six eyes (Group B, medium macular thickness 700±20 micron) had pars plana TSV 25 G with additional ILM peeling after PHM removal. Visual acuity (ETDRS) and central macular thickness at 1, 3, and 6 months were measured by Optical Coherence Tomography (STRATUS OCT 3). Results: In Group A, residual medium macular thickness was 260±20 micron with one line improvement visual acuity. At the same time, in group B edema resolved completely (medium macular thickness 188micron) in 5 eyes with a two lines visual acuity improvement. Conclusions: Minimal Central Vitrectomy by TSV 25 G with ILM peeling seems more effective and long–lasting than standard Intravitreal Triamcinolone Acetonide without ILM peeling in reducing diffuse diabetic macular edema.

Keywords: diabetic retinopathy • vitreoretinal surgery