Vitrectomy results in diabetic macula oedema without evident vitreomacular traction.

Abstract

The authors sought to determine the effectiveness of vitrectomy in eyes with diabetic macular edema without evident traction from a thickened vitreous membrane. Twenty-one consecutive eyes from 19 patients with diabetic macular edema that had undergone vitrectomy were analyzed retrospectively. All eyes had an attached posterior hyaloid membrane in the macular region, but without thickening and without evident traction on the macula. A standard pars plana vitrectomy with the creation of a posterior vitreous detachment was performed. The median duration of macular edema at the time of vitrectomy was approximately 11 months (range, 2–36 months). The median preoperative best-corrected visual acuity of 0.08 improved by 5 lines to a median final postoperative best-corrected visual acuity of 0.25 (P = 0.001). Seven eyes without preoperative macular photocoagulation had a median visual acuity improvement of 77% (range, 32–400%) while 12 eyes with preoperative macular laser treatment had a median visual acuity improvement of 14.8% (range, 0–66.1%) (P = 0.02). In all 21 eyes, macular edema was no longer visible on microscopic examination after a median period of 3 months (range, 1–9 months) after vitrectomy. The authors conclude that in eyes with diabetic macular edema without evident macular traction from a thickened vitreous membrane, vitrectomy resulted in the resolution of macular edema with an improvement in visual acuity in the majority of cases. Eyes without preoperative macular photocoagulation had a significantly higher percentage visual improvement than eyes without preoperative macular laser treatment. A randomized controlled prospective trial of primary vitrectomy versus macular photocoagulation is needed to determine the role of vitrectomy as a treatment modality for diabetic macular edema.—Thomas J. Liesegang