Abstract
PurposeTo compare the anatomical and functional outcomes of severe diabetic macular edema (DME) with massive hard exudates managed by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or nonsurgical treatment.MethodsWe retrospectively reviewed 40 eyes with DME and massive hard exudates treated with either PPV with ILM peeling (vitrectomy group, 21 eyes) or nonsurgical treatment with anti-vascular endothelium growth factor (VEGF) and/or steroids (nonsurgical group, 19 eyes). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) and resolution of macular hard exudates were compared between the two groups.ResultsAfter treatment, CRT decreased steadily in the vitrectomy group but fluctuated in the nonsurgical group. Compared with eyes in the nonsurgical group, eyes in the vitrectomy group had better visual improvement (P < 0.05 at 6 and 12 months and the final visit) and greater decrease in CRT (P < 0.05 at 3 and 6 months and the final visit) after adjustment for baseline BCVA. Hard exudates resolved more rapidly in the vitrectomy group than in the nonsurgical group, with 94.1% versus 47.4% eyes showing significant absorption after 6 months of the treatment (P = 0.003). In the vitrectomy group, 62% eyes did not require any further injections for treating DME after the operation.ConclusionsPPV with ILM peeling resulted in rapid resolution of hard exudates with significant anatomical and functional improvement in DME with massive hard exudates.
Highlights
Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetic retinopathy [1, 2]
pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling resulted in rapid resolution of hard exudates with significant anatomical and functional improvement in DME with massive hard exudates
Inclusion criteria were as follows: (1) presence of DME with massive hard exudates, which were defined as fovea-involved, single or multiple patches of confluent hard exudates with a total area of >3 disc areas at the posterior pole confirmed by color fundus photography; (2) presence of intraretinal and/or subretinal hyperreflective materials involving the fovea confirmed by optical coherence topography (OCT); and (3) a best-corrected visual acuity (BCVA) of 20/200
Summary
Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetic retinopathy [1, 2]. Several treatment modalities such as focal laser photocoagulation [3], intravitreal or subtenon injection of triamcinolone [4, 5], sustained-release corticosteroids implant [6, 7], and intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) [8, 9] have been proposed to manage DME. IVIs of anti-VEGF are considered the firstline treatment of choice for DME, whereas IVI of corticosteroids may be considered for pseudophakic eyes or patients with a high risk of thromboembolic events. Vitrectomy combined with internal limiting membrane (ILM) peeling has shown favorable anatomical and functional outcomes [18,19,20,21,22]
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