Comparison of anatomical and functional outcomes of vitrectomy with internal limiting membrane peeling in recalcitrant diabetic macular edema with and without traction in Indian patients

Abstract

Purpose: To study and compare the outcomes of pars plana vitrectomy (PPV) with the internal limiting membrane (ILM) peeling in the eyes with recalcitrant diabetic macular edema (DME) with and without vitreomacular traction. Methods: A comparative prospective interventional study was undertaken in which group 1 included 45 eyes of 45 patients with DME with vitreomacular tractional component and group 2 included 45 eyes of 45 patients with recalcitrant DME without a tractional component. Both groups underwent standard PPV with ILM peeling. All the patients were followed up for a minimum of 6 months. The parameters evaluated were changes in the best-corrected visual acuity (BCVA), central macular thickness (CMT), multifocal electroretinogram (mfERG) parameters, and occurrence of any intraoperative/postoperative surgical complication. Results: The mean CMT improved significantly from 540.6 and 490.2 μm at the baseline to 292.5 and 270.6 μm at 6 months in groups 1 and 2, respectively ( P < 0.001). The mean BCVA logMAR improved from 0.78 ± 0.21 to 0.62 ± 0.22 in group 1 and 0.84 ± 0.19 to 0.65 ± 0.21 in group 2 at 6 months follow-up which was not statistically significant. The improvement in the mfERG was seen in group 2 as a significant increase in P 1 wave amplitude in ring 2 (2–5°) ( P < 0.004) and a significant decrease in P 1 wave implicit time in ring 1 (central 2°) ( P < 0.001). None of the eyes suffered from the loss of BCVA or any major surgical complication in either group. Conclusion: PPV in recalcitrant DME provides good anatomical outcomes and the results are comparable in DME with and without a tractional component.

Surgical Drainage of Large Macular Cystoid Spaces in Coats Disease

“…6 More recent studies show that vitrectomy with ILM peeling may also provide visual improvements that are potentially comparable to anti-VEGF therapy. 7,8 Unlike DME, Coats disease presents with severe edema with abnormal telangiectasias, leaking aneurysms, and subretinal exudates, occasionally resulting in serous retinal detachments (RDs) that more often affect the peripheral retina. Although the management of peripheral Coats lesions involves laser or cryopexy, exudative RDs may require internal or external surgical drainage of the serous fluid and lipid exudates with PPV.…”

“…6 More recent studies show that vitrectomy with ILM peeling may also provide visual improvements that are potentially comparable to anti-VEGF therapy. 7,8…”

Current Treatments for Diabetic Macular Edema

“…On the other hand, the effectiveness of vitrectomy for DME refractory to anti-VEGF therapy has been reported [152][153][154]. It is believed that vitrectomy may be a suitable treatment option for DME patients who are refractory to anti-VEGF therapy or had multiple recurrences after the anti-VEGF therapy [79].…”

Mid-term safety and effectiveness of macular peeling one month after intravitreal dexamethasone implant for tractional diabetic macular edema

“…Vitrectomy may be considered when there is little or no response to non-surgical treatments 10,11 or in cases in which DME is associated with vitreomacular traction (VMT) or ERM [11][12][13][14] . After surgery, the anatomical outcome has been shown to be better than functional recovery 15 .…”

“…DEX-i performed one month before surgery seemed to be a safe approach and ensured a greater and faster recovery considering functional and tomographic parameters.Diabetic macular edema (DME) affects approximately 6.8% of the diabetic population 1 and 20% of the patients with diabetic retinopathy 2 , being the major cause of vision loss in these patients 3,4. The incidence of epiretinal membrane (ERM) in DME patients has been reported to be 13-34% on structural optical coherence tomography (OCT) imaging 5-8 and 46.9% on En-face OCT imaging 9 .Vitrectomy may be considered when there is little or no response to non-surgical treatments 10,11 or in cases in which DME is associated with vitreomacular traction (VMT) or ERM [11][12][13][14] . After surgery, the anatomical outcome has been shown to be better than functional recovery 15 .…”