Abstract
Purpose :
To compare the efficacy of vitrectomy, membranectomy and internal limiting membrane (ILM) peeling with the corresponding surgically untreated fellow eye in patients with diabetic macular edema (DME) and non-tractional epiretinal membrane (NT-ERM).
Methods :
Patients diagnosed with bilateral DME and NT-ERM, with one eye surgically treated with 23 gauge pars plana vitrectomy, membranectomy and ILM peeling were retrospectively evaluated and compared to the corresponding fellow eye. The first visit before surgery was considered as baseline and data were collected at 1, 3, 6 months, 1 and 2 years. Best corrected visual acuity (BCVA) was obtained with ETDRS charts and complete ophthalmic examination were collected from medical records. Fluorescein angiography (FA) images were obtained at baseline and SD-OCT images were collected at every follow-up.
Results :
10 patients were included, 6 females and 4 males, with a mean age of 62 years old (ranging from 59 to 66). All eyes were previously treated with grid laser and a mean of 4 intravitreal injection of bevacizumab (ranging from 1 to 7). At last follow up, vitrectomized eyes showed a mean BCVA gain of 1 line ETDRS (ranging from -2 and +2 lines) and a mean foveal thickness reduction of -57% (ranging from -41 to -79%), starting from a mean foveal thickness of 606 µm (ranging from 380 to 819 µm), no intravitreal injection with antiVEGF was required. All fellow eyes required intravitreal injections of ranibizumab (mean number of 4, ranging from 1 to 7), the mean foveal thickness at baseline was 356 µm (ranging from 234 to 558 µm) and the mean BCVA gain after each intravitreal injection was +2 ETDRS lines (ranging from 0 to +4).
Conclusions :
Vitrectomy, membranectomy and ILM peeling reduces foveal thickness without a significant gain in BCVA. Fellow eye required treatment with intravitreal injection of ranibizumab with a better visual outcome after each procedure. Although vitrectomy seems to stabilize the foveal condition over a period of 2 years, intravitreal injections of ranibizumab is a safer procedure to manage DME with NT-ERM in a responsive patient.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.