Surgical Management of Diabetic Macular Edema

Mikhail, Mikel; Hassan, Tarek

doi:10.1007/978-981-33-4168-5_19

Cited by 3 publications

(1 citation statement)

References 67 publications

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“…The dense ILM found in diabetic patients also retards oxygen diffusion from the vitreous into the retinal tissue [ 20 ]. The main goal of surgery is to isolate the posterior hyaloid from the macula, and ILM peeling ensures that all hyaloidal elements are released [ 21 ]. Some researchers believe that ILM peeling does not add additional benefits to PPV for DME treatment.…”

Section: Discussionmentioning

confidence: 99%

Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling

Khattab¹,

Ahmed²,

Hammed³

2022

Med Hypothesis Discov Innov Ophthalmol

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Background: The effectiveness of internal limiting membrane (ILM) peeling in the surgical treatment of tractional diabetic macular edema (DME), although widely examined, remains controversial. This study aimed to assess the efficacy of pars plana vitrectomy (PPV) in the management of tractional DME and to highlight any benefits of additional ILM peeling. Methods: This was an open-label, prospective, comparative, and interventional study that enrolled 50 eyes with tractional DME that underwent PPV and allocated each to one of two groups: group A consisted of 25 eyes that had no ILM peeling and group B consisted of 25 eyes that underwent ILM peeling. Postoperative assessments of best-corrected distance visual acuity (BCDVA) in the logarithm of minimal angle of resolution (logMAR) notation and central macular thickness (CMT) were performed at 1, 3, and 6 months postoperatively. Results: At baseline, the two groups were comparable in terms of sex ratios, phakic status, insulin use, coexistence of hypertension, and mean (standard deviation [SD]) age, BCDVA, CMT, duration of diabetes mellitus, and glycosylated hemoglobin (HbA1c) levels. In group A, the mean (SD) BCDVA improved significantly from 0.89 (0.12) logMAR preoperatively to 0.64 (0.24) logMAR (P < 0.001), and the mean (SD) CMT declined significantly from 471.28 (80.83) micrometer to 228.20 (26.45) micrometer (P < 0.001), at the 6-month postoperative assessment. Likewise, in group B, the mean (SD) BCDVA improved significantly from 0.83 (0.10) logMAR preoperatively to 0.58 (0.24) logMAR (P < 0.001), and the mean (SD) CMT decreased significantly from 496.84 (89.82) micrometer to 226.20 (18.04) micrometer (P < 0.001), after 6 months. There were no significant differences between groups A and B in the changes in BCDVA (Delta BCDVA) or CMT (Delta CMT) at 1, 3, and 6 months postoperatively with respect to the baseline values (all P > 0.05). Postoperative complications were comparable between the two groups. A significant negative correlation was detected between the preoperative HbA1c level and BCDVA improvement in all participants (r = - 0.82; P < 0.001). Conclusions: PPV is an effective treatment for tractional DME. Additional ILM peeling was not significantly associated with functional and anatomical benefits over a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in patients with diabetes. Further long-term studies are required to verify our findings.

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Section: Discussionmentioning

confidence: 99%

Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling

Khattab¹,

Ahmed²,

Hammed³

2022

Med Hypothesis Discov Innov Ophthalmol

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Pars Plana Vitrectomy for Tractional Diabetic Macular Edema with or without Internal Limiting Membrane Peeling

Khattab

Ahmed

Hammed

2022

Preprint

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Background To assess the efficacy of pars plana vitrectomy (PPV) in management of tractional diabetic macular edema (DME) and highlight the benefits of additional internal limiting membrane (ILM) peeling. Methods This prospective study involved 50 eyes with tractional DME that underwent PPV were split into two groups: group (A) consisted of 25 eyes that did not have ILM peeling, and group (B) consisted of 25 eyes that did. One, three, and six months after surgery, a postoperative assessment was completed. Results Mean best corrected visual acuity (BCVA) in group (A) has improved from (0.89 the logarithm of minimal angle of resolution [LogMAR]) preoperatively to (0.64 LogMAR, p < 0.001), and mean central macular thickness (CMT) declined from (471.28µm) to (228.20µm, p < 0.001) after six months of PPV. In group (B), mean BCVA has improved from (0.83 LogMAR) preoperatively to (0.58 LogMAR, p < 0.001), and mean CMT decreased from (496.84µm) to (226.20µm, p < 0.001) after six months of PPV. There were no significant differences between the two groups after 1, 3, and 6 months according to the delta change % of BCVA and CMT. A significant negative correlation was detected between preoperative glycosylated hemoglobin (HbA1c) and BCVA improvement. Conclusions PPV surgery is an effective treatment of tractional DME. Additional ILM peeling is not accompanied by extra benefits in a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in diabetic patients.

show abstract

Pars Plana Vitrectomy for Tractional Diabetic Macular Edema with or without Internal Limiting Membrane Peeling

Khattab

Ahmed

Hammed

2022

Preprint

View full text Add to dashboard Cite

Background: To assess the efficacy of pars plana vitrectomy (PPV) in management of tractional diabetic macular edema (DME) and highlight the benefits of additional internal limiting membrane (ILM) peeling. Methods: This an open-label, prospective, comparative and interventional study that enrolled 50 eyes with tractional DME that underwent PPV were split into two groups: group (A) consisted of 25 eyes that did not have ILM peeling, and group (B) consisted of 25 eyes that did. One, three, and six months after surgery, a postoperative assessment was completed. Results: Mean best corrected visual acuity (BCVA) in group (A) has improved from (0.89 the logarithm of minimal angle of resolution [LogMAR]) preoperatively to (0.64 LogMAR, p <0.001), and mean central macular thickness (CMT) declined from (471.28μm) to (228.20μm, p <0.001) after six months of PPV. In group (B), mean BCVA has improved from (0.83 LogMAR) preoperatively to (0.58 LogMAR, p <0.001), and mean CMT decreased from (496.84μm) to (226.20μm, p <0.001) after six months of PPV. There were no significant differences between the two groups after 1, 3, and 6 months according to the delta change % of BCVA and CMT. A significant negative correlation was detected between preoperative glycosylated hemoglobin (HbA1c) and BCVA improvement. Conclusions: PPV surgery is an effective treatment of tractional DME. Additional ILM peeling is not accompanied by extra benefits in a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in diabetic patients.

show abstract

Surgical Management of Diabetic Macular Edema

Cited by 3 publications

References 67 publications

Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling

Pars plana vitrectomy for tractional diabetic macular edema with or without internal limiting membrane peeling

Pars Plana Vitrectomy for Tractional Diabetic Macular Edema with or without Internal Limiting Membrane Peeling

Pars Plana Vitrectomy for Tractional Diabetic Macular Edema with or without Internal Limiting Membrane Peeling

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