Ist die Entfernung der Membrana limitans interna (ILM) immer erforderlich bei Patienten mit dem therapierefraktären diffusen diabetischen Makulaödem ohne Nachweis von epimakulären Proliferationen?

Abstract

Vitrectomy with or without ILM peeling may improve BCVA and decrease foveal thickness. ILM peeling was not found to enhance the improvement of VA postoperatively. A larger study is required to determine whether ILM peeling is essential in surgery for DME without epimacular proliferation or cellophane maculopathy.

Complications of Macular Peeling

“…ILM peeling has been used in some cases of refractory diabetic macular edema (DME) after failed intravitreal injections of anti-VEGF, steroids, and/or laser photocoagulation, with decrease in foveal thickness but with no improvement of visual acuity postoperatively [ 160 – 163 ]. In branch and central retinal vein occlusion-associated macular edema, there are few series of selected cases that show improvement in visual acuity after PPV with the removal of preretinal hyaloid and peeling of the ILM [ 164 – 166 ].…”

Benefit Of Vitrectomy And Internal Limiting Membrane Peeling In The Treatment Of Resistant Diabetic Macular Edema

“…In Academy, the bene t of ILM peeling for the patients undergoing PPV for DME is still a dilemma (26, 27 difference between the groups in the rst 6 months, they reported that the decrease in foveal thickness and macular volume was statistically signi cantly higher in the group with ILM peeling in the following period (15). Aboutable reported in a study on patients with diffuse DME without epimacular membranes, ILM peeling reduced foveal thickness and did not improve visual acuity improvement compared to nonpeeling (11). Bahadir et al reported in their randomized controlled study that ILM peeling did not cause a signi cant improvement in visual acuity compared to non-peeling in patients who underwent PPV for DME treatment (16).…”

“…Although there are many studies in the literature claiming that ILM peeling is bene cial in the presence of vitreomacular traction (VMT) in patients with diabetic retinopathy, the bene t of performing this procedure in the absence of VMT is controversial (9)(10)(11)(12)(13)(14)(15)(16). There are some randomized studies demostrated that ILM peeling had unfavourable outcomes, such as statistically signi cant absolute microscotomas within the central retinal area (17).…”