Outcomes of vitrectomy, membranectomy and internal limiting membrane peeling in patients with refractory diabetic macular edema and non-tractional epiretinal membrane

Abstract

PurposeTo evaluate the efficacy of vitrectomy, membranectomy, and internal limiting membrane (ILM) peeling on macular thickness and best corrected visual acuity (BCVA) in patients with refractory diffuse diabetic macular edema (DME) and non-tractional epiretinal membrane (NT-ERM).MethodsThis prospective interventional case series included eyes with refractory DME (central subfield macular thickness [CSMT] > 300 μm) after at least two intravitreal injections of bevacizumab (IVB) and one intravitreal injection of triamcinolone (IVT), and accompanying NT-ERM. Complete ophthalmic examination, baseline spectral domain optical coherence tomography (SD-OCT), and fluorescein angiography (FA) were performed prior to 23 gauge pars plana vitrectomy with membranectomy and internal limiting membrane (ILM) peeling. Postoperative evaluation was done with clinical examination and SD-OCT. Linear mix model analysis was used to study postoperative results.ResultsTwelve eyes from 11 patients (5 males) with a mean age of 60.33 ± 9.01 (range 46–73 years) were included. The mean follow-up time was 13.5 ± 4.48 months (range 4–20 months). A significant reduction in CSMT was found (from 559 ± 89 μm to 354 ± 76 μm; P = 0.001), with a non-significant BCVA change (from 0.84 ± 0.32 logMAR to 0.72 ± 0.2 logMAR; P = 0.967). There was no significant correlation between CSMT and BCVA (partial correlation = −0.115, P = 0.445) and also between estimated mean CSMT change per month and estimated mean BCVA change per month (r = 0.337, P = 0.283).ConclusionIn this series, our results did not show that vitrectomy, membranectomy, and ILM peeling result in significant improvement of BCVA in eyes with refractory DME and non-tractional ERM in spite of central macular thickness reduction.

Optical Coherence Tomography (Angiography) Biomarkers in the Assessment and Monitoring of Diabetic Macular Edema

“…The term describing this abnormal vitreomacular relationship is taut posterior hyaloid membrane and is responsible for recalcitrant macular edema. OCT reveals taut posterior hyaloid membrane, identifying the patients with DME who could benefit from pars plana vitrectomy and removal of the posterior hyaloid [ 35 ].…”

Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs

“…There are many strategies in the management of resistant DME, such as switching to another anti-VEGF [23], switching to sustained-release steroid implants [24], combining treatments [25], or surgical intervention [26]. Continuation of anti-VEGF in the absence of satisfactory response was also suggested based on a proposed category of “late responders” [27].…”

Management of Refractory Diabetic Macular Edema: A Review Article

“…Ghassemi et al evaluated the effectiveness of PPV with membranectomy and ILM peeling in the treatment of eyes with refractory DME and non-tractional epiretinal membrane. 68 All patients were treated before surgery with at least 2 intravitreal bevacizumab injections and 1 intravitreal triamcinolone acetonide injection. In all, 12 eyes from 11 patients were evaluated and followed-up for a mean period of 14.5 months.…”