Vitrectomy with internal limiting membrane peeling versus nonsurgical treatment for diabetic macular edema with massive hard exudates

Abstract

To compare the anatomical and functional outcomes of severe diabetic macular edema (DME) with massive hard exudates managed by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or nonsurgical treatment. Methods We retrospectively reviewed 40 eyes with DME and massive hard exudates treated with either PPV with ILM peeling (vitrectomy group, 21 eyes) or nonsurgical treatment with antivascular endothelium growth factor (VEGF) and/or steroids (nonsurgical group, 19 eyes). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) and resolution of macular hard exudates were compared between the two groups. Results After treatment, CRT decreased steadily in the vitrectomy group but fluctuated in the nonsurgical group. Compared with eyes in the nonsurgical group, eyes in the vitrectomy group had better visual improvement (P < 0.05 at 6 and 12 months and the final visit) and greater decrease in CRT (P < 0.05 at 3 and 6 months and the final visit) after adjustment for baseline BCVA. Hard exudates resolved more rapidly in the vitrectomy group than in the nonsurgical group, with 94.1% versus 47.4% eyes showing significant absorption after 6 months of the treatment (P = 0.003). In the vitrectomy group, 62% eyes did not require any further injections for treating DME after the operation. Conclusions PPV with ILM peeling resulted in rapid resolution of hard exudates with significant anatomical and functional improvement in DME with massive hard exudates.

Internal Limiting Membrane Peeling versus Nonpeeling to Prevent Epiretinal Membrane Formation following Vitrectomy for Posterior Segment Open-Globe Injury

“…Several studies have shown that ILM peeling has some beneficial effects for the prevention of ERM formation in various retinal diseases, including RRD [ 10 ], proliferative diabetic retinopathy [ 11 ], and PVR [ 12 ]. For patients with an OGI who undergo a successful PPV, the formation of an ERM may be detrimental to visual function, and some may need a secondary operation.…”

High-Risk Diabetic Maculopathy: Features and Management

“…The participants in Protocol T were enrolled at an average age of 61 years [45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Secondary analysis of the baseline factors associated with visual outcome after 2 years of intensive anti-VEGF treatment revealed that even in such a relatively young cohort with every decade of age the scope of mean visual improvement decreased by 2.1 EDTRS letters.…”

“…[53] using 25-G PPV and ILM peeling and the report of Lin HC et al [54] on 23-G vitrectomy with ILM peeling as a first line treatment for DME demonstrate substantial increase and stabilization of visual acuity, macular fluid resolution and rapid regression of hard exudates, without additional therapy up to 24 months post surgery. Prognostic factors associated with a greater visual gain include no history of prior macula laser treatment, lower hemoglobin A1c, recent onset of the edema and younger age, however delay of the procedure and damage of the IS/OS and ellipsoid zone at baseline had negative effect on the vision gain 12 and 24 months postoperatively.…”

Гемофтальм Після Оперативного Лікування Діабетичної Ретинопатії У Хворих На Цукровий Діабет 2-Го Типу

“…Підвищення проникності капілярів як один із компонентів типового патологічного процесу за умов ДР призводить до випадіння адвентицію, зміни кровообігу в сітківці та стає предиктором розвитку ПДР [27]. Гемодинамічно значуще звуження капілярів сітківки з оклюзією їх просвіту стає причиною необоротних змін клітинного метаболізму, дисфункції ендотелію, підвищує ламкість судин та за кінцевим підсумком збільшує ймовірність післяопераційних крововиливів [28].…”