Abstract
This study is for reporting the outcomes of internal limiting membrane (ILM) peeling on persistent submacular fluid (PSF) after otherwise successful pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD). In this retrospective case series, five consecutive patients (5 eyes) who exhibited PSF following successful repair of diabetic TRD were included. The second operation was performed to remove ILM. The area of ILM peeling was expanded up to the major vascular arcade. Only air tamponade was used. The median interval between the first PPV and the second PPV with ILM peeling was 4.8 months (range: 4–6 months). PSF resolved completely within one (2 eyes) or 2 months after ILM peeling. The median logMAR best-corrected visual acuity (BCVA) was improved from 1.00 (Snellen equivalent 20/200) to 0.70 (Snellen equivalent 20/100). In conclusion, wide ILM peeling is an effective treatment option for PSF subsequent to successful repair of diabetic TRD. ILM peeling might increase the elasticity of retina, thereby allowing the retina to flatten. This procedure can induce faster retinal reattachment in diabetic TRD involving the macula.
Highlights
Tractional retinal detachment (TRD) that involves the macula is the main cause of permanent vision loss in patients with diabetic retinopathy and requires prompt surgical intervention [1, 2]
In five consecutive patients who exhibited persistent submacular fluid (PSF) after successful repair of diabetic TRD, internal limiting membrane (ILM) peeling was performed as a secondary procedure
We reviewed the charts and imaging records of consecutive patients who exhibited prolonged PSF after successful pars plana vitrectomy (PPV) to treat diabetic TRD and underwent secondary operation of ILM peeling
Summary
Tractional retinal detachment (TRD) that involves the macula is the main cause of permanent vision loss in patients with diabetic retinopathy and requires prompt surgical intervention [1, 2]. In a recent prospective study including 23 patients (24 eyes) with macula-off diabetic TRD who underwent successful PPV, the prevalence of PSF on spectral-domain OCT (SD-OCT) was 100% at 2 months, 91.7% at 3 months, 70.8% at 6 months, 25.0% at 9 months, and 4.2% at 1 year [6]. It means that delayed residual subfoveal fluid resorption is a common phenomenon in clinically successful surgery. In five consecutive patients who exhibited PSF after successful repair of diabetic TRD, ILM peeling was performed as a secondary procedure. Fluid-air exchange was performed for all eyes, and face-down positioning was recommended for 1–3 days
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