Surgical Management of Diabetic Macular Edema

Abstract

Diabetic retinopathy is a leading cause of vision loss among working age adults. Diabetic macular edema (DME) and complications related to neovascularization (vitreous hemorrhage, retinal detachment) are the major causes of visual loss in patients with diabetes mellitus. 1,2 In the Early Treatment of Diabetic Retinopathy Study (ETDRS), the 3-year risk of moderate visual loss [a decrease of 3 or more lines on a logarithmic visual acuity (VA) chart, or a doubling of the visual angle] among untreated eyes with clinically significant DME (DME involving or threatening the central macula) was 32%. 3 The pathogenesis of DME is multifactorial, predominantly involving retinal vascular hyperpermeability; however, the vitreoretinal interface may also play a role by causing mechanical disruption of the macula. 4-7 Over the years, the standard management of DME has included systemic risk factor control in addition to photocoagulation (focal and/or grid laser), intravitreal injection of antivascular endothelial growth factor (anti-VEGF) agents, intravitreal injection of corticosteroids, and vitrectomy surgery. [8][9][10][11] Here we review the surgical options for the management of DME, with an emphasis on patients with vitreoretinal interface pathology. ' Rationale for Surgical InterventionAlthough advances in the medical management of DME have resulted in improved patient outcomes, the role of surgery remains an area of active interest. Vitrectomy remains a theoretically appealing

Cataract surgery in diabetes mellitus: A systematic review

“…[ 39 94 95 ] Internal limiting membrane (ILM) peeling in the eyes with persistent DME has been shown to be beneficial. [ 96 ] However, it is also known that the ILM in diabetics is more difficult to peel due to increased adhesions.…”

Surgical Management and Techniques

“…The glycated diabetic ILM acts as a semipermeable membrane, retaining leaked proteins within the retina. The rise in the oncotic pressure sustains fluid ingress from the vitreous into the retina [39] Patterns of Vitreoretinal Interface: the different presentation patterns of vitreoretinal attachment may be helpful in making a decision for surgery [40] . Imaging techniques (SD-OCT and FA) are critical in aiding the surgeon to identify the interface status.…”