Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema

Ranno, Stefano; Vujosevic, Stela; Mambretti, Manuela; Metrangolo, Cristian; Alkabes, Micol; Rabbiolo, Giovanni; Govetto, Andrea; Carini, Elisa; Nucci, Paolo; Radice, Paolo

doi:10.3390/jcm12062297

Cited by 4 publications

(1 citation statement)

References 38 publications

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“…Rinaldi et al analyzed 672 patients with non-traction DME in a in a retrospective analysis, combined with peeling of the ILM did not yield a significant difference in VA and anatomical improvement compared with PPV [86]. Similarly, Ranno et al reached a similar conclusion [87]. Currently, there is an ongoing VVV-DME study aimed at exploring the effect of early PPV combined with ILM stripping in patients with primary DME [88], More clinical trials are needed to demonstrate the efficacy and safety of different surgical approaches and timing of surgery for DME.…”

Section: Surgical Treatmentmentioning

confidence: 86%

Progress in the Treatment of DME

Zou,

Liu,

Cheng

et al. 2024

JBM

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Diabetic macular edema (DME) is a common ocular complication of diabetes mellitus (DM) and an important cause of vision loss. The pathogenesis of DME is complex and can occur at any time of diabetic retinopathy (DR). Effective methods of treating DME are essential to prevent irreversible damage to visual function. To date, laser photocoagulation, vascular endothelial growth factor (VEGF) inhibitors, and corticosteroids have demonstrated their therapeutic efficacy in large randomized controlled trials and real-life observational studies. Clinicians need to consider various factors, such as efficacy, safety, accessibility, and cost, in the selection of various options. This review summarizes the current therapeutic approaches for DME to provide new references for the treatment of DM.

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Section: Surgical Treatmentmentioning

confidence: 86%

Progress in the Treatment of DME

Zou,

Liu,

Cheng

et al. 2024

JBM

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Microinvasive pars plana vitrectomy combined with internal limiting membrane peeling versus anti-VEGF intravitreal injection for treatment-naïve diabetic macular edema (VVV-DME study): study protocol for a randomized controlled trial

Guo,

Li,

Nie

et al. 2023

Trials

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Background Diabetic macular edema (DME) is the main cause of vision loss in diabetic patients. Currently, anti-vascular endothelial growth factor (VEGF) intravitreal injection stands as the first-line therapy for DME. However, some patients exhibit insufficient response to anti-VEGF agents and often require multiple injections, imposing psychological and economic burdens. While microinvasive pars plana vitrectomy (PPV) has been shown to be safe and effective in treating refractory DME, scant research has explored its application to treatment-naïve DME. The purpose of this study is to determine whether early PPV combined with internal limiting membrane (ILM) peeling can lessen the therapeutic burden of DME patients, prevent vision loss, and maintain long-term stabilization of diabetic retinopathy. Methods This is a single-center, prospective, parallel-group, non-inferiority randomized controlled trial involving 102 DME participants. Participants will be randomly assigned to either the study group (PPV combined with ILM peeling) or the control group (conbercept intravitreal injection (IVC)) at a 1:1 ratio, with a scheduled follow-up at 12 months post-operation. Comparative analysis of results between the two groups will be conducted at months 1, 3, 6, and 12 after the intervention. The primary outcomes involve evaluating the changes in central subfield thickness (CST) and best corrected visual acuity (BCVA). The secondary outcomes include assessment of optical coherence tomography (OCT) and OCT angiography (OCTA) biomarkers, re-treatment and adverse events rates, diabetic retinopathy (DR) development, cost-effectiveness analysis, and vision-related quality of life (VRQL). Discussion Some patients do not respond well to anti-VEGF drugs and repeated intravitreal injections increase the treatment burden for patients. The VVV study aims to explore whether PPV combined with ILM peeling could become an initial treatment option for treatment-naïve DME patients. Trial registration ClinicalTrials.gov NCT05728476. Registered on 15 February 2023.

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Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema

Wang,

Chen,

Wang

et al. 2024

World J Clin Cases

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BACKGROUND Diabetic macular edema (DME), a chronic microvascular complication of diabetes, is a leading cause of visual impairment and blindness. Pars plana vitrectomy (PPV) can restore the normal macular structure and reduce macular edema, whereas internal limiting membrane (ILM) peeling is used to treat tractional macular diseases. Despite the advantages, there is limited research on the combined effects of PPV with ILM peeling. AIM To observe the effects of PPV combined with ILM peeling on postoperative central macular thickness (CMT), best-corrected visual acuity (BCVA), cystoid macular edema (CME) volume, and complications in patients with DME. METHODS Eighty-one patients (92 eyes) diagnosed with DME at the Beijing Shanqu Liangxiang Hospital between January and December 2022 were randomly divided to undergo PPV alone (control group: 41 patients, 47 eyes) or PPV + ILM peeling (stripping group: 40 patients, 45 eyes); a single surgeon performed all surgeries. The two groups were compared preoperatively and 1 and 3 months postoperatively. RESULTS Preoperatively, both groups had comparable values of CMT, BCVA, and CME volume (P > 0.05). After surgery (both 1 and 3 months), both groups showed significant reductions in CMT, BCVA, and CME volume compared to preoperative levels, with the stripping group showing more significant reductions compared to the control group (P < 0.05). Further repeated-measures ANOVA analysis for within-group differences revealed significant effects of group and time, and interaction effects for CMT, BCVA, and CME volume (P < 0.05). There were no significant differences in the incidence of complications between the groups (retinal detachment: control = 2, stripping = 1; endophthalmitis: Control = 4, stripping = 1; no cases of secondary glaucoma or macular holes; χ 2 = 0.296, P = 0.587). CONCLUSION PPV with ILM peeling can significantly improve the visual acuity of patients with DME, reduce CMT, and improve CME with fewer complications.

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Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema

Cited by 4 publications

References 38 publications

Progress in the Treatment of DME

Progress in the Treatment of DME

Microinvasive pars plana vitrectomy combined with internal limiting membrane peeling versus anti-VEGF intravitreal injection for treatment-naïve diabetic macular edema (VVV-DME study): study protocol for a randomized controlled trial

Effects of vitrectomy combined with internal limiting membrane peeling in patients with diabetic macular edema

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