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

Abstract

Purpose of the Study: To study preoperative and postoperative optical coherence tomography features and the outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for full-thickness macular holes (MHs) associated with proliferative diabetic retinopathy. Methods: The data from 14 eyes of 11 patients with full-thickness macular holes and active diabetic fibrovascular proliferation (FVP) with/without tractional retinal detachment who underwent pars plana vitrectomy and standard ILM peeling at Zarifa Aliyeva National Ophthalmology Centre in Baku were analysed. Bilateral surgery for diabetic MHs was performed in 27.3% of patients. The minimum follow-up duration was 6 months. Results: All eyes (100%) achieved type 1 macular hole closure, with residual macular subretinal fluid (SRF) present in 13 cases after surgery (92.9%). The SRF resolved gradually without any interventions. The incidence of SRF was 92.9% at 1 month, 85.7% at 3 months, 50% at 6 months, and 14.3% at 9 months (Cochran's Q test, χ2 (4) =37.44, p<0.001). Visual acuity improved after surgery in 13 cases (92.9%), with a mean difference of 0.75 ±0.71 LogMAR between the preoperative and final values, r s =0.608, 95% BCa CI [0.037-0.969], p=0.021. Conclusion: The standard ILM peeling technique for full-thickness MHs in eyes with active diabetic fibrovascular proliferation can help restore the anatomy and function of the macula in diabetic patients. Close follow-up is important for unilateral cases. Residual SRF in the perifoveal area is detectable by OCT after surgery in patients with macular holes associated with diabetic tractional retinal detachment, and it usually resorbs gradually without any interventions.

Comparative Analysis of the Effects of the Anti-VEGF Drug and Glucocorticoid by Injection before the End of Vitrectomy for Proliferative Diabetic Retinopathy

“…This is related to a lower postsurgical VEGF level in group A. Combretase reduces microvascular permeability, reduces its chance of leakage, and reduces local edema, thereby optimizing CMT. With the improvement of microvascular status, the patient's microcirculation level and macular blood flow density were improved, indicating that the recovery of material transport capacity promoted the recovery of the patient's vision [ 16 – 18 ]. Therefore, for China with 2.5 million PDR patients, conbercept is of high value to be promoted in clinics.…”

Surgical outcome of full-thickness macular hole secondary to tractional retinal detachment in proliferative diabetic retinopathy

“…As a result, detachment around the MH is usually larger than the simple cuff seen in the idiopathic FTMH. [ 2 3 8 16 17 18 19 ]…”

“…Similar to that reported in the literature, the anatomical outcome in our study was also cent percent. [ 3 7 10 ]…”

“…[ 1 ] MH has been reported in nearly 1.6% eyes undergoing vitrectomy for proliferative DR (PDR). [ 2 3 ] MH in these eyes occurs secondary to the traction produced by active fibrovascular proliferation (FVP) on the foveal edges, which are already weakened by edema and ischemia. [ 4 ]…”

“…[ 3 7 8 9 10 ] Some authors even suggest conservative management for eyes with FTMH and macula attached TRD as the results are not very encouraging. [ 2 3 4 7 8 ] Another controversy related to the management of such eyes is the role of internal limiting membrane (ILM) peeling. [ 2 8 11 12 ]…”