Vitrectomy Results for Diffuse Diabetic Macular Edema with and without Inner Limiting Membrane Removal

Stefaniotou, Maria; Aspiotis, Miltiadis; Kalogeropoulos, Chris; Christodoulou, Aikaterini; Psylla, M.; Ioachim, Elli; Alamanos, Ioannis; Psilas, K

doi:10.1177/112067210401400209

Cited by 63 publications

(47 citation statements)

References 22 publications

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“…Stefaniotou et al [131] retrospectively analyzed the results obtained in 73 eyes treated with PPV with or without ILM peeling. BCVA gains could be observed in both groups, but a greater improvement could be seen in patients undergoing ILM peeling.…”

mentioning

confidence: 99%

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

García-Arumí²,

et al. 2017

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Diabetic retinal disease is envisioned to become the plague of the coming decades with a steep increase of worldwide diabetes incidence followed by a substantial rise in retinal disease. Improvements in diagnostic and therapeutic care have to cope with this dilemma in a clinically and socioeconomically efficient manner. Laser treatment has found a less destructive competitor in pharmacological treatments. As a consequence of recent rigorous clinical trials, laser photocoagulation is no longer recommended for the treatment of diabetic macular edema (DME), and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids have maintained a role in the management of chronically persistent DME. The paradigm shifts in therapy are accompanied by a substantial break-through in diagnostics. The following guidance for the management of DME has been composed from the best updated knowledge of leading experts in Europe and represents another volume in the series of EURETINA recommendations for the management of retinal disease.

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confidence: 99%

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

García-Arumí²,

et al. 2017

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“…Commonly, the release of traction and the removal of vitreous humor to reduce cytokines and angiogenic factors are thought to stand behind the success of vitrectomy in diabetic patients [14][15][16]. To achieve this, induction of a posterior vitreous detachment appears to be of particular importance [19].…”

mentioning

confidence: 97%

Kallikrein-kinin activation by altered vitreous pH: New perspectives for treatment and pathogenesis of diabetic macular edema?

Zeitz

Keserü

2007

Graefes Arch Clin Exp Ophthalmol

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Recently, Gao et al. published an experimental study based on the pathophysiology of diabetic macular edema in Nature Medicine (Nat Med. 2007 Feb;13(2):181-8). They found an increased amount of carbonic anhydrase in the vitreous, which causes a pH shift. This activates the kallikrein-kinin system and leads to increased retinal vascular permeability. In this comment the clinical implications of this article are discussed.

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“…Previous investigators reported a positive impact of pars plana vitrectomy in DME [25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64]. Vitrectomy with removal of the premacular posterior hyaloid may resolve the DME and improve vision in patients who previously failed to respond to conventional laser treatment.…”

Section: Pars Plana Vitrectomymentioning

confidence: 99%

“…In the following years, numerous retrospective studies have shown the advantage of vitrectomy and removal of the posterior hyaloid on morphologic and functional results [34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65]. Harbour et al [35], Pendergast [36] and Kaiser et al [39] evaluated the surgical results in patients with a thickened and taut posterior hyaloid membrane in combination with DME and stated that early surgical intervention may result in better visual outcome.…”

Section: Pars Plana Vitrectomymentioning

confidence: 99%

Current Treatment Approaches in Diabetic Macular Edema

Meyer¹

2007

Ophthalmologica

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Purpose: To review current treatment approaches in diabetic macular edema (DME). Methods: The underlying pathopathology, classifications and diagnostic examination techniques including fluorescein angiography, optical coherence tomography and stereoscopic biomicroscopy. Treatment modalities with focal or grid argon laser photocoagulation, pars plana vitrectomy with and without peeling of the inner limiting membrane (ILM), as well as intravitreal injections using triamcinolone acetonide or novel vascular endothelial growth factor (VEGF) inhibitors are described. Results: DME results from a series of biochemical and cellular changes, causing progressive leakage and exudation. Focal and grid photocoagulation remains the standard care for diabetic maculopathy. However, the availability of new agents raises the possibility of improvements if significant benefits can be validated in randomized clinical trials. Posterior vitreous attachments play a critical role through several mechanical or physiological mechanisms. Vitrectomy without ILM removal seems to be effective in reducing the retinal thickness and improving visual acuity. Conclusion: A proper evaluation of the vitreous and retina is fundamental to select the most appropriate treatment approach in DME. While small microaneurysms with focal DME may be treated by conventional focal photocoagulation, diffuse DME which do not respond to grid photocoagulation may benefit from intravitreal injections using triamcinolone acetonide or novel VEGF inhibitors. Eyes with DME and additional vitreous traction may benefit from pars plana vitrectomy without ILM peeling. A combination of laser, pharmacological and surgical treatment modalities may be necessary to maintain central vision in eyes with DME.

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Vitrectomy Results for Diffuse Diabetic Macular Edema with and without Inner Limiting Membrane Removal

Abstract: In eyes with diffuse diabetic macular edema vitrectomy seems to be effective, but additional ILM peeling presented better results.

Cited by 63 publications

References 22 publications

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA)

Kallikrein-kinin activation by altered vitreous pH: New perspectives for treatment and pathogenesis of diabetic macular edema?

Current Treatment Approaches in Diabetic Macular Edema

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