Epiretinal Membrane in Patients with Diabetic Macular Edema: To Peel or not to Peel?

Abstract

Purpose : To compare anatomical and functional outcomes of pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peeling in diabetes mellitus (DM) patients with and without diabetic macular edema (DME).

Methods : A retrospective interventional case series of consecutive patients who underwent PPV with ERM peeling. Patients were divided into two groups: With and without preoperative DME. Visual acuity (VA) and optical coherence tomography (OCT) parameters were evaluated before surgery and during 12 months follow-up.

Results : A total of 354 patients underwent PPV with ERM peeling, of which 81 met the inclusion criteria. Twenty-three were diagnosed with DME and were younger (66.3±9.6 vs 75.1±8.5years, p<0.001), had longer DM duration (18.9±7.1 vs 14.3±11.4 years, p=0.04) and higher HbA1C% (7.6±1.4 vs. 7.0±1.1, p=0.01). VA improved from 20/105 to 20/60 Snellen (p=0.004) and central macular thickness (CMT) decreased from 469.3±64.9μm to 331.1±92.2μm (p<0.001) in the DME group and from 20/80 to 20/45 Snellen (p<0.001) and from 478.9±77.4μm to 353.1±64.1μm (p<0.001) in the non DME group. Yearly intravitreal injections rate decreased from 5.9±2.5 to 2.9±3.0 (p<0.001) injections in the DME group.

Conclusions : DME patients with ERM, experience significant improvement in VA, macular thickness and yearly intravitreal injections after PPV with ERM peeling. DME patients are younger, with lower VA, longer duration of DM and higher HbA1C% levels at presentation in comparison to diabetic ERM patients without DME.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Results of vitrectomy with ERM peeling in 72 years old male, treated for DME with 10 bevacizumab injections in the last 12 months prior to surgery and only 2 injections in the 12 months following surgery. During the 12 months follow up period there is a gradual improvement in BCVA and macular thickness. Spectral-domain OCT images display: (A) at presentation, CMT 340 µm, BCVA 20/100. (B) 3 months postoperatively, CMT 304 µm, BCVA 20/80 and (C) 12 months postoperatively, CMT 262 µm, BCVA 20/50. As noted, there is reabsorption of all intra retinal fluid and hyper reflective foci and marked improvement in retinal integrity and continuity with restoration of EZ disruption

 

. Mean best corrected visual acuity (BCVA) during 12 months follow-up in DME and non-DME groups.