Pars Plana Vitrectomy and Removal of the Internal Limiting Membrane in Diabetic Macular Edema Unresponsive to Grid Laser Photocoagulation

Abstract

PPV with ILM removal appears to be an effective procedure for reducing diabetic macular edema unresponsive to grid laser photocoagulation. A further study with a large number of patients is required to assess the effectiveness and safety of this procedure.

Quantitative Assessment of Photoreceptor Layer in Eyes with Resolved Edema after Pars Plana Vitrectomy with Internal Limiting Membrane Removal for Diabetic Macular Edema

“…Several studies have reported favorable results by reducing or resolving DME and improving VA following PPV combined with ILM removal [3,4,5,6,7,8,9,10,11,12]. However, anatomical outcome may not always be correlated with functional results after PPV with ILM removal.…”

“…Earlier studies involving OCT mostly focused on macular edema and a correlation was found between visual acuity (VA) and reduction in central macular thickness [7,8,9,10,11,12]. However, some eyes with DME have a poor visual outcome despite resolution of macular edema after successful treatment [13,14,15,16,17,18].…”

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

“…26. Consider vitrectomy in eyes with chronic or diffuse DME that is non-responsive to laser treatment (Level III-1 evidence) [45][46][47][48] , or if related to vitreomacular traction (Level III-1 evidence). 27.…”

“…However, to date, the few RCT of vitrectomy for DME (Table 3.2.1) have relatively small sample size and short follow-up, with inconsistent results [45][46][47][48] .…”

Vitrectomy for diabetic macular oedema

“…15,19,37,41,50,51 Our trial included 40 patients 19 with an attached but otherwise normal posterior hyaloid (ie, no clinical traction or PVD), who were randomised to either more laser or vitrectomy with ILM peeling. We found no clinically or statistically significant difference in acuity or macular thickness reduction between the lasered control and vitrectomy groups at 12 months follow-up.…”