Pars plana vitrectomy and internal limiting membrane peeling for macular edema secondary to retinal vein occlusion

Abstract

Purpose:To evaluate the effects of vitrectomy and internal limiting membrane peeling for treatment of macular edema secondary to retinal vein occlusion (RVO).Methods:Nine cases of visual loss due to macular edema caused by central retinal vein occlusion or branch retinal vein occlusion underwent pars plana vitrectomy with removal of the preretinal hyaloid, peeling of the internal limiting membrane stained with indocyanine green dye, air–fluid exchange, and postoperative prone positioning. Best-corrected visual acuity (BCVA) and central foveal thickness by optical coherence tomography were measured pre- and postoperatively then compared to assess the outcome of surgery.Results:In all cases intraretinal blood and retinal thickening diminished within 2 months of surgery. Visual acuity improved in all of the central retinal vein occlusion cases and 3/6 branch retinal vein occlusion cases. The decrease in macular thickness was statistically significant (mean postoperative macular thickness 361 ± 61.1 versus mean preoperative macular thickness 563.9 ± 90.0, P = 0.001, t-test). The improvement in BCVA was not statistically significant (mean preoperative BCVA in LogMAR 1.23 ± 0.29 versus mean postoperative BCVA in LogMAR 1.06 ± 0.49, P = 0.09, t-test).Conclusion:In eyes with macular edema secondary to RVO, pars plana vitrectomy with internal limiting membrane peeling can resolve macular edema, but the improvement in BCVA was not statistically significant in this study.

Strategy for the Management of Macular Edema in Retinal Vein Occlusion: The European VitreoRetinal Society Macular Edema Study

“…Pars plana vitrectomy (PPV) with peeling of the internal limiting membrane (ILM) has been an option in the treatment of edema in RVO for many years [ 22 , 23 ]. More recent investigations have shown improvement of edema in both BRVO and CRVO following treatment with PPV [ 24 – 27 ]. The efficacy of combination therapy including vitrectomy is not completely understood.…”

Internal Limiting Membrane (ILM) Peeling for Macular Edema Secondary to Branch Retinal Vein Occlusion (BRVO)

“…22 Hariri et al reported that PPV with ILM peeling resulted in decreasing macular edema but the improvement in BCVA was not statistically significant. 4 Mandelcorn reported decrease in macular thickness within an average of 39 days after PPV and ILM peeling. 20 Long-term effects of ILM peeling were also reported by Kumagai et al There was no recurrence of macular edema at one year follow-up which is consistent with our study.…”

“…Vascular occlusion leads to the expression of interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF), both of which lead to the development of macular edema which reduces vision. 4 Treatment has evolved significantly over the past few years with the aim of treating macular edema in branch retinal vein occlusion (BRVO). Grid laser photocoagulation was used to treat macular edema in a specific group of patients with BRVO, while promising results were observed with intravitreal injections of anti-VEGF (vascular endothelial growth factor) or steroids.…”

Pars Plana Vitrectomy Combined with Internal Limiting Membrane Peeling to Treat Persistent Macular Edema after Anti-Vascular Endothelial Growth Factor Treatment in Cases of Ischemic Central Retinal Vein Occlusion

“…Previously, several investigators have reported the anatomical and functional efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling in CRVO-associated ME [ 7 , 8 , 9 , 10 ]. However, some also reported that a reduction in ME is not accompanied by visual improvement [ 11 , 12 , 13 ]. In cases of ME that have not been improved by repeated anti-VEGF treatment, surgical intervention may be a viable treatment option.…”