Pars Plana Vitrectomy with Internal Limiting Membranectomy for Diabetic Macular Edema

Abstract

Abstract: : Purpose: To investigate the effect of pars plana vitrectomy with internal limiting membrane peeling on refractory diabetic macular edema. Design: Retrospective interventional series Methods: Review of patients who were treated with pars plana vitrectomy with internal limiting membrane peel for diabetic macular edema. Twenty six eyes of 20 consecutive patients who received at least two focal lasers with persistent diffuse diabectic macular edema were included. Results: The mean age of the patients studied was 63 and average follow up was 221 days (Range 66 –544). Sixteen of the 26 were phakic and 10 were pseudophakic. There was a statistical significant improvement of mean visual acuity from a preoperative logmar vision of 1.0 to a best post operative vision of 0.60. (p=.001 paried t-test) Thirteen (50%) of the eyes gained at least two lines of snellen acuity, 3 (11.5%) had a decline of at least 2 lines and 10 (38.5%) showed stable visions. Sixteen (61%) of the eyes had pre and post op OCT. Fifteen of the sixteen had a significant improvement of retinal thickness with an average preoperative thickness of 623um to a post operative OCT of 355um.(t=3.65, p=.0001) No complications were observed related to the treatment. Conclusions: Surgery for refractory diabetic edema is associated with a significant improvemnent in visual acuity and diminution of retinal thickness as measured by OCT. Combination of ILM peeling along with vitrectomy may be usefull in a selected subset of patients with diabetic macular edema.

Keywords: diabetic retinopathy