Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane

Diabetic retinopathy

“…Because of its rarity and difficult diagnosis, most studies on this condition are limited to small series. Some authors [153,154,155,156] reported positive outcomes in up to 90% of eyes, with visual acuity improving to 5/10 or more in almost 30%. However, the benefits seem to be short-lived, as acuity can drop again in the medium-long term and the indications for surgery in diabetic macular edema have yet to be established more firmly.…”

Influence of the epiretinal membrane on ranibizumab therapy outcomes in patients with diabetic macular edema

“…Recent studies have shown that IL-6 induces the expression of VEGF, the most important primary mediator of retinal (10,11) . VEGF and its receptors, as well as IL-6, localize to cells in the vascular and avascular epiretinal membranes (ERMs) of patients with diabetic retinopathy, thus further increasing inflammation (12,13) and possibly promoting persistent DME. Although patients with ERM likely require more frequent injections for inflammation, ERMs may act as a physical barrier and decrease drug penetration.…”

Intravitreal bevacizumab (Avastin) for primary treatment of diabetic macular oedema

“…7 However, some treated eyes may be resistant to laser photocoagulation or efficient laser treatment could not be performed due to diffuse macular oedema. Therefore, the failure of laser photocoagulation in these eyes has prompted interest in other treatment modalities, such as intravitreal triamcinolone acetonide (IVTA) injection, 4,5,8,9 pars plana vitrectomy, 10,11 or treatment with protein kinase C inhibitors. 12 Retinal hypoxia is the primary cause of diabetic retinopathy, which increases expression of vascular endothelial growth factor (VEGF).…”