Evaluating the adjunctive surgical procedures of vitrectomy for diabetic macular edema

Abstract

Abstract: : Purpose: To evaluate adjunctive surgical procedures of pars plana vitrectomy (PPV) for the therapy of diabetic macular edema (DME) Methods: This study is consecutive interventional case series. Sixty–one eyes of fifty–six patients with diabetic macular edema that had undergone vitrectomy were retrospectively analysed. The eyes were classified according to surgical procedure into three groups: 13 eyes (groupI) treated by a vitrectomy without triamcinolone–acetonide (TA); 25 eyes (group II) treated by a TA–assisted vitrectomy; 23 eyes (group III) treated by a TA–assisted vitrectomy with peeling of the internal limiting membrane (ILM). Analysis of the three groups was performed using the postoperative best–corrected visual acuity (BCVA: logMAR units) after 6 months, and the correlation between BCVA and patient age was evaluated. Results: The mean preoperative BCVA was 0.89. The mean postoperative BCVA after 6 months and the final BCVA were 0.76 and 0.70, respectively. The postoperative BCVA after 6 months resulted in improvement, invariability and deterioration levels of 36%, 43% and 21%, respectively. The final postoperative BCVA (average of 16.1 months) resulted in improvement, invariability and deterioration levels of 51%, 33% and 16%, respectively.The percentage of postoperative visual improvement of Group I, Group II, and Group III was 38.5%, 40.5%, and 30.4%, respectively, that we found no significant statistical differences in the improvement levels of the three groups tested (P=0.168). There was a negative correlation between postoperative BCVA and patient age in group II (P=0.007). There was a positive correlation between postoperative BCVA and patient age in group III (P=0.014). These correlations were statistically significant. There was no statistically significant correlation between postoperative BCVA and patient age in group I (P=0.482). Conclusions: The present study suggests it’s better to perform triamcinolone–assisted PPV without peeling ILM in younger patients or patients with early diabetic retinopathy. Moreover, ILM peeling may be more useful for DME in older patients or patients with advanced diabetic retinopathy.

Keywords: vitreoretinal surgery • diabetic retinopathy • visual acuity