Three-year outcomes of vitrectomy combined with intraoperative dexamethasone implantation for non-tractional refractory diabetic macular edema

Abstract

This retrospective, consecutive interventional study investigated the long-term clinical outcomes of combined vitrectomy with intraoperative dexamethasone implants for non-tractional refractory diabetic macular edema (DME). The study included 43 eyes from 39 participants with DME that had continued for more than 6 months despite repeated non-surgical treatment. Postoperative changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated over 3 years. A Kaplan–Meier curve was obtained for any additional non-surgical treatment, and the average number of non-surgical treatments required for DME before and after surgery was compared. Other postsurgical complications were also investigated. The logMAR BCVA improved from 0.526 ± 0.417 (20/67) preoperatively to 0.294 ± 0.374 (20/39) 3 years postoperatively (p < 0.001, generalized estimating equation). The CMT improved from 478 ± 122 μm preoperatively to 314 ± 90 μm 3 years postoperatively (p < 0.001, generalized estimating equation). Additional non-surgical treatment was not required for 29 (67%) eyes. The average number of annual non-surgical treatments decreased from 5.04 times preoperatively to 0.34 times postoperatively. Seventeen (40%) eyes developed temporary ocular hypertension after surgery, which normalized after antihypertensive eye drop instillation. In conclusion, vitrectomy combined with intraoperative dexamethasone implantation provides satisfactory long-term clinical outcomes for non-tractional refractory DME while reducing the number of intraocular injections for DME.

Epiretinal Membrane Peeling in Eyes with Retinal Vein Occlusion: Visual and Morphologic Outcomes

“…Moreover, the removal of ERM may increase the drug penetration into the retina after intravitreal injections [7,8]. A beneficial effect of ILM peeling during vitrectomy for RVO has also been correlated with decompression of the edematous retina [30], even though ILM peeling was not found to be significantly associated with treatment outcomes in our cohort.…”

“…Previous studies have examined the outcomes of secondary ERM surgical removal in eyes with tractional diabetic macular edema, reporting good anatomical and variable functional results [7,8]. In addition, pars plana vitrectomy (PPV) has been proven effective in ERM due to uveitis or trauma [9,10].…”

Infrared reflectance image-guided laser photocoagulation of telangiectatic capillaries in persistent diabetic macular edema

“…Persistent DME refractory to various non-surgical treatments can be challenging to treat and manage 17 , 18 . A previous study reported that TelCap was associated with chronic macular edema refractory to intravitreal treatment 10 .…”

Vitrectomy in Diabetic Retinopathy

“…While some studies show that patients with refractory DME would benefit with vitrectomy [26], other studies have shown no significant visual improvement with ILM peeling although there may be anatomical improvement [27,28]. Addition of intravitreal steroid along with ILM peeling in some cases of refractory DME, has shown to improve visual outcome in longterm [29].…”