Abstract

PurposeTo evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling.MethodsMedical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent).ResultsNinety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 ± 0.28 and 0.52 ± 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 ± 209.1 μm preoperatively and 327 ± 66.1 μm postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 ± 0.14 vs. 0.7 ± 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 ± 54.6 μm; ELM disruption: 334 ± 75.2, p = 0.31).ConclusionsPPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact.

Highlights

  • Diabetic macular edema (DME) is a complication of diabetes and represents one of the leading causes of legal blindness

  • external limiting membrane (ELM) disruption grade 1 was observed in 4 eyes (21.1%), grade 2 in 3 eyes (15.8%) and grade 3 in 4 eyes (21.1%)

  • Anti-VEGF treatment was continued in 10 eyes and in 2 of these eyes Ozurdex® was applied due to reduced effectivity of anti-VEGF

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Summary

Introduction

Diabetic macular edema (DME) is a complication of diabetes and represents one of the leading causes of legal blindness. Characteristic features of DME include an abnormal intra- and eventually sub-retinal fluid. Specific structural OCT biomarkers may guide the choice of treatment and monitor the therapeutic response [2]. The effectivity of intravitreal treatment can significantly decrease over time, especially in presence of concomitant vitreoretinal interface pathology including traction, thickened vitreous cortex or epiretinal membrane (ERM) [6, 7]. The glial cells of ERMs express various cytokines and growth factors including VEGF and contribute to the maintenance of DME [14, 15]. ERMs serve as a mechanical barrier which reduces the permeability of intravitreal anti-VEGF and steroids through the ERM [16]

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