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G.F. Roessler, S. Radetzky, P. Walter, B. Kirchhof, A.M. Joussen; Visual Outcome of Patients with Macular Edema after Pars Plana Vitrectomy (PPV) and Indocyanine Green (ICG) Assisted Internal Limiting Membrane (ILM) Peeling . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3025.
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Purpose: To evaluate the efficacy of inner limiting membrane (ILM) peeling in persistent macular edema. Methods: This retrospective review analyzes a series of 23 eyes from 23 patients with persistent macular edema after pars plana vitrectomy (PPV) with indocyanine green (ICG) assisted peeling of the ILM. Thirteen female and 12 male patients with a mean age of 57.2 ± 15.6 (24-77) years were operated between May 2000 and October 2001. The main diagnoses were uveitis (anterior, intermedia, posterior and panuveitis) (n=9), central retinal vein occlusion (CRVO) (n=4), diabetic retinopathy (DR) (n=5), vitreoretinal traction syndrome (n=2) and Irvine-Gass-Syndrome (n=3). 9 eyes had undergone phacoemulsification (PE) previously and 2 eyes underwent combined PE and ILM-peeling. The eyes were tamponaded with gas (3), silicone oil (5) or air (11). In 4 cases no endotamponade was used. Improvement in visual acuity of 2 lines or more was determined as being significant. Results: Visual acuity improved after 3 months in 9/23. After 6 months and at the follow up a significant improvement was found in 6/21 and 7/21 of the patients. This improvement was predominantly seen in patients with uveitis (5/9), or diabetic maculopathy (3/5); One patient with Irvine-Gass syndrom showed significant reduction, one with vitreoretinal traction showed improvement in visual acuity. The group of CRVO showed no significant change during the follow-up. The choice of endotamponade did not alter the visual acuity outcome. Conclusions: Although overall only in 1/3 of all cases significant visual acuity improvement was observed 12 months after ILM peeling for persistent macular edema, patients with uveitis and non-proliferative diabetic maculopathy demonstrated a benefit. The lack of long-term improvement in the majority of cases is in accordance with the hypothesis that ILM peeling may reduce the intraretinal edema, but does not affect the underlying mechanism causing macular edema. Large-scale investigations are needed to evaluate the efficacy in certain diagnosis groups.
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