Surgical management of diabetic macular edema – Against

Abstract

SummaryDiabetic macular edema (DME) is the leading cause of visual impairment in patients with diabetes mellitus. Disruption of the blood‐retinal‐barrier has been implicated to the pathogenesis of DME. In addition, vascular endothelial growth factor (VEGF) and other inflammatory mediators have been found to be major contributors to angiogenesis and to increased vascular permeability, leading to DME.Although surgical management of DME has been proposed as a treatment option, since it releases vitreous traction at the macula and improves oxygenation of the posterior segment, complications and persistence of macular edema postoperatively put this treatment modality in suspicion. In fact, eyes with refractory edema and no observable traction seem less likely to improve after surgical treatment. Moreover, in the majority of cases, there is no functional improvement, despite the encouraging anatomical results.Nowadays, anti‐VEGF agents still remain the standard of care in the management of DME, while intravitreal steroids gain interest as well. In cases, in which DME coexists with vitreoretinal interface pathology, pars plana vitrectomy in selected cases may be useful.