Infracyanine green–assisted peeling of the internal limiting membrane in the treatment of refractory diabetic macular edema

Abstract

Abstract: : Purpose: To evaluate the efficacy of pars plana vitrectomy with infracyanine green–assisted internal limiting membrane peeling for the treatment of refractory diabetic macular edema. Methods: Noncomparative interventional case series. Nine consecutive eyes of 8 patients with diabetic macular edema refractory to laser treatment and with evidence of vitreomacular traction were included in the study. Patients underwent ETDRS visual acuity examination, dilated ophthalmoscopy, fluorescein angiography, and optical coherence tomography before treatment and during follow–up. Patients underwent a three–port pars plana vitrectomy with complete posterior hyaloid and epiretinal membrane removal. The internal limiting membrane was stained with infracyanine (0.5 mg/ml) and peeled up to the vascular arcades. Panretinal photocoagulation and cataract phacoemulsification were performed if indicated. Results: Intraoperatively, the hyaloid was attached or partially attached in all 9 eyes. An epiretinal membrane was present in 3 eyes. Mean follow–up was 12 ± 3.9 months (range 4– 15 months). During follow–up, 7 eyes remained phakic and 2 eyes received cataract surgery. Median visul acuity was 20/100 (range 20/400–20/40) before surgery and 20/80 (range 20/160–20/25) after surgery. Seven eyes improved (≥ 2 lines) and 2 eyes remained stable (0–1 line). Overall, there was a mean improvement of 3 lines (range 0–11 lines). Mean retinal thickness was 366 ± 98 mm before surgery and reduced to 225 ± 64 mm after surgery. No evidence of retinal pigment epithelium or retinal changes due to surgery were recorded and none of the patients complained of scotoma after vitrectomy. No other complications were observed. Conclusions:Although the follow–up time and number of patients in this pilot study are limited, the encouraging results and lack of complications suggest that infracyanine green–assisted peeling of the internal limiting membrane may be useful in the treatment of refractory tractional diabetic macular edema. Further studies are indicated.

Keywords: diabetic retinopathy • vitreoretinal surgery