Visual Acuity Comparison of Vitrectomy with and without Internal Limiting Membrane Removal in the Treatment of Diabetic Macular Edema

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To evaluate whether internal limiting membrane (ILM) peeling during vitrectomy affects vision outcome in patients with diabetic macular edema. Fifty-eight eyes of 49 patients were included in the study. Patients with persistent diffuse clinically significant macular edema were divided into two groups according to the surgical method used. Group I subjects (15 patients; mean age 56.60+/-8.50 years; 17 eyes total) underwent vitrectomy with ILM peeling. Group II subjects (34 patients; mean age 57.52+/-11.54 years; 41 eyes total) underwent vitrectomy without ILM peeling. The data recorded for each case were type and duration of diabetes, insulin treatment (yes/no), presence of arterial hypertension, stage of diabetic retinopathy, lens status, history of macular laser treatment, and detection of posterior vitreous detachment during surgery. Visual acuity was measured preoperatively and 1 year postoperatively in decimal notation, and values were converted to logarithm of minimal-angle-of-resolution (logMAR) scores. Mean pre- and postoperative visual acuity were compared within each group, and the mean change in visual acuity in Group I was compared to that in Group II. There were no significant differences between the groups with respect to age; sex distribution; diabetes type; duration of diabetes; numbers of patients on insulin treatment; frequencies of hypertension, proliferative diabetic retinopathy, previous macular laser treatment; or frequency of intraoperatively confirmed posterior vitreous detachment (chi-square, P>0.05 for all). Comparison of pre- and post-operative visual acuity revealed significant improvement in both Group I (1.15+/-0.307 vs. 0.764+/-0.355 logMAR, respectively; Wilcoxon rank test, P<0.01) and Group II (1.22+/-0.516 vs. 0.829+/-0.436 logMAR, respectively; Wilcoxon rank test, P<0.001). The change in visual acuity for Group I was not significantly different from that observed in Group II (0.391+/-0.335 vs. 0.393+/-0.273 logMAR, respectively; Mann-Whitney U test, P>0.05). The visual acuity outcomes in the study indicate that vitrectomy without ILM peeling is just as effective as vitrectomy with ILM peeling in the treatment of diabetic macular edema. Both techniques led to significant and similar degrees of improvement in visual acuity.