Pars Plana Vitrectomy for the Treatment of Diabetic Macular Edema with or without Internal Limiting Membrane Peeling: A Systematic Review and Meta-Analysis

Abstract

Background Diabetic macular edema (DME) is defined as a retinal thickening in one-disc diameter (DD) of the centre of the macula. It is a number of microvascular retinal changes that lead to blood–retinal barrier (BRB) disruption, causing leakage of fluid and plasma components into the inner and outer plexiform layers. Aim of the Work The aim of the study was to conduct a systematic review and a meta-analysis estimating the efficacy of pars plana vitrectomy with and without internal limiting membrane peeling in treating non tractional refractory diabetic macular edema. Materials and Methods A comprehensive literature search was conducted using the databases Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies from 1 January 2000 to 1 August 2020. This meta-analysis included 14 studies. They were randomized controlled clinical trials (RCTs), and about 647 patients with DME (753 eyes) participated in these studies. Results This study demonstrated no statistically significant change in the mean of best corrected visual acuity (BCVA) improvement and central macular thickness (CMT) in both groups when comparing the baseline to one- and three-month follow-ups after the procedure, though with no statistically significant difference in the ILM compared to the non ILM group. Conclusion Pars plana vitrectomy with or without ILM peeling improves the long-term visual acuity of nontractional diabetic macular edema. Internal limiting membrane peeling, does not affect the postoperative best-corrected visual acuity significantly.