Vitrectomy Outcomes in Eyes with Tractional Diabetic Macular Edema

Abstract

Purpose: To evaluate pars plana vitrectomy (PPV) outcomes in cases with tractional diabetic macular edema (tDME). Methods: We conducted a single-center retrospective study with a follow-up of 12 months. Forty-six eyes with tDME of 38 patients submitted to PPV between 2013 and 2015 were assessed. A standard PPV was performed and surgical outcomes were registered at the 3-, 6-, and 12-month follow-up. Results: The baseline median best corrected visual acuity (BCVA) in ETDRS (Early Treatment Diabetic Retinopathy Study) letters and the median central foveal thickness (CFT) were 43.0 letters and 491.0 µm, respectively. At the 12-month follow-up, a median decrease in CFT of 232.7 µm was observed. A CFT < 300 µm was achieved in 65.2% of the cases (52.2% needing no further treatment); a BCVA improvement by ≥10 letters was achieved in 60.0%, but there was a decrease of ≥10 letters in 13.0% of the cases. DME recurrence was observed in 10.9% of the cases, with a median time of development after vitrectomy of 6 months. As a major postoperative complication, a macular hole was observed in 1 patient (2.1%). Conclusions: In our series, PPV for tDME induced an improvement in retinal thickening and visual outcome in more than 50% of the cases, with low recurrence rates and a low number of postoperative complications.

<p>Pars Plana Vitrectomy for Full-Thickness Macular Holes in Patients with Proliferative Diabetic Retinopathy and Active Fibrovascular Proliferation</p>

“…Some authors suppose that long-standing macular oedema with tractional forces can easily cause MHs, with oedematous macula in particular being vulnerable to vitreous traction. 6,17 Cystoid macular edema, which may be an additional causative factor in the development of macular holes, was found in 85.7% of our cases, and the epiretinal membrane was identified in all cases preoperatively. Since we did not observe cystic changes in all cases, we suggest that tangential traction is the most important factor for MH development.…”

Evaluation of Macular Changes in the Long Term after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema

“…The effect of internal limiting membrane (ILM) peeling on DME has also been investigated, and it has been found that this can result in a lower rate of recurrence following surgery [12]. The incidence of additional therapy following surgery has been reported as 6-20% in studies with a shorter follow-up [13,14].…”

Two cases of diabetic macular edema complicated by an atypical macular hole

“…Lee et al reported a case of MH that developed after intravitreal injection of bevacizumab for DME, speculating that traction by the vitreous body incarcerated at the site of insertion of the vitreous injection and change in the properties of the vitreous body by injection are involved as a trigger in the development of the MH [5]. Pessoa et al performed PPV in 46 eyes of 38 patients with DME with vitreous traction, and reported that an MH developed in 1 eye after surgery [6]. Yamamoto et al reported that there are two types of MH associated with PDR, i.e., an MH due to traction and an MH due to cystoid macular edema [7].…”

“…Treatment for diabetic macular edema (DME) includes the topical administration of steroids and anti-vascular endothelial growth factor (anti-VEGF) agents, as well as pars plana vitrectomy (PPV). However, studies have reported the development of a macular hole (MH) during the course of these treatments [1][2][3][4][5][6][7]. Here we report 2 cases of MHs that developed following anti-VEGF therapy and PPV for DME in which the MH showed the formation of a convex surface toward the vitreous cavity, unlike a typical idiopathic MH, and discuss the cause of the MH in each case.…”