Strategy for the Management of Diabetic Macular Edema: The European Vitreo-Retinal Society Macular Edema Study

Abstract

Objective. To compare the efficacy of different therapies in the treatment of diabetic macular edema (DME). Design. Nonrandomized, multicenter clinical study. Participants. 86 retina specialists from 29 countries provided clinical information on 2,603 patients with macular edema including 870 patients with DME. Methods. Reported data included the type and number of treatment(s) performed, the pre- and posttreatment visual acuities, and other clinical findings. The results were analyzed by the French INSEE (National Institute of Statistics and Economic Studies). Main Outcome Measures. Mean change of visual acuity and mean number of treatments performed. Results. The change in visual acuity over time in response to each treatment was plotted in second order polynomial regression trend lines. Intravitreal triamcinolone monotherapy resulted in some improvement in vision. Treatment with threshold or subthreshold grid laser also resulted in minimal vision gain. Anti-VEGF therapy resulted in more significant visual improvement. Treatment with pars plana vitrectomy and internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than that observed with anti-VEGF injection alone. In our DME study, treatment with vitrectomy and ILM peeling alone resulted in the better visual improvement compared to other therapies.

Giant Retinal Tear Management at Referral Eye Hospital

“…5 Meanwhile, other surgeonsreserve scleral buckling only for second intervention. 3 In this study, we found that retinal re-attachment was successful with combine PPV with encircling buckle in 4/7 eyes (57%) and PPV alone was 42% (8/19 eyes). Ambresin et al, reported the success rate of management of GRT with vitrectomy, internal tamponade, and peripheral 360 degrees photocoagulation of the retina without scleral buckle is high (94.4%).…”

“…3,12 However this procedure has also been implicated in complicating the closure of GRT due to distortion of the shape of the eye, fish-mouthing and tendency to increase 'slippage' of the retina posteriorly and the possible induction of PVR due to additional trauma. 3,8 Conversely, other surgeons prefer adjunctive buckling in as a primary procedure aiming to reduce the failure rate. Their rationale was that scleral buckling reduces the early and late tractional forces and supports areas of un-detected retinal breaks.…”

“…Their management poses significant challenges due to the many complications and technical difficulties involved for unfolding and sealing the retinal tear. [1][2][3][4] Although GRT can occur spontaneously, they are often associated with a number of conditions; this include ocular trauma, high myopia, pseudophakia, hereditary conditions, for example, Marfan syndrome, Stickler syndrome, extensive Lattice degeneration and young age. 5,6 With such a large tear, the anterior insertion of the retina no longer offers peripheral support and the retina folds back on itself.…”

Treatment trials for diabetic macular oedema

“…Recently, the superiority of ILM peeling over other therapies for DMO has been suggested by a non-randomised study. 6 If future trials of intravitreal therapies for DMO are contemplated, one arm of the study should comprise vitrectomy and ILM peeling. The review is an excellent summary of all literature on this interesting topic; nevertheless, one of the largest surgical case series is missing.…”

Reply to ‘Comments on Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants’

“…Recently, the superiority of ILM peeling over other therapies for DMO has been suggested by a non-randomised study. 6 If future trials of intravitreal therapies for DMO are contemplated, one arm of the study should comprise vitrectomy and ILM peeling.…”