Vitrectomy For Diabetic Macular Edema Research Articles

Vitrectomy in Diabetic Macular Edema:: A Swept-source OCT Angiography Study.

The foveal avascular zone (FAZ) has been reported to decrease after anti-VEGF injections in diabetic macular edema (DME) in the long term. This study aimed to present the changes in swept-source OCT angiography after vitrectomy in patients with DME. Retrospective interventional study. Thirty-five eyes were included (mean age: 62 years). Patients were followed for 12 months after vitrectomy with internal limiting membrane peeling for DME. The following parameters were measured: central retinal thickness (CRT), central choroidal thickness, superficial FAZ, deep FAZ (dFAZ), and vessel density in the superficial and deep retinal layers (dVD). The CRT and superficial FAZ significantly decreased after surgery (401 μm-338 μm; P<0.00, 401 μm-293 μm; P<0.001, respectively). Initial visual acuity (VA) improved from 20/160 (0.97 logarithm of the minimum angle of resolution [LogMAR]) to 20/80 (0.62 LogMAR) (P<0.001). The vessel density in the superficial retinal layers rate was 42.3% and decreased after surgery, reaching 41.6% at the end of the follow-up. The dVD rate 1 week after surgery was 28.9% and remained stable throughout the observation period. The most important prognostic factors for the final VA were preoperative VA and preoperative CRT, while the dFAZ and dVD at the time of edema resolution also correlated with the final VA. The superficial FAZ decreases after vitrectomy, which might indicate that vitrectomy has a protective effect on DME, similar to anti-VEGF injections. Prognostic factors for better final functional results are better initial VA and lower CRT before vitrectomy, in addition to a lower dFAZ diameter and a higher dVD at the moment of edema resolution. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Evaluation of Macular Function after Vitrectomy in Diabetic Macular Edema

Purpose: To document the effects of successful vitrectomy on retinal function and anatomy in diabetic patients. Methods: Three-port pars plana vitrectomy with detachment of posterior vitrous face was performed in 30 eyes of 25 patients with diabetic macular oedema DME (11 male, 14 Female).For each patients, visual acuity (VA) examination, measurement of retinal thickness using optical coherence tomography (OCT), full field electro-retinogram (ERG) and multifocal eletroretinogram (MF-ERG) were performed before and 1week,1month and 3months after vitrectomy. Results: Mean postoperative visual acuity was significantly improved (P&lt;0.05); mean retinal thickness was significantly (P=0.001 ) decreased after 3monthes of surgery (from 450±150 into 220±50 micron ) .b-wave amplitudes of all cone and rod responses of ERG were significantly decreased in all vitrectomized eyes after 1 week. At one month, rod response was still unimproved but improved after 3months. Reduction in foveal Function as well as in para-foveal areas detected in the MF-ERG within 1st month. Then, mean P1 wave amplitude of MF-ERG of central ring increased and mean P1 wave implicit time decreased. These changes of MF-ERG parameters observed 3 months after vitrectomy. Conclusion: Multifocal electroretinogram can be useful to provide objective criteria for functional evaluation before and after vitrectomy in diabetic oedema.

Thorough Perioperative Laser Photocoagulation in Prevention of Neovascular Glaucoma after Vitrectomy for Diabetic Macular Edema

Neovascular glaucoma (NVG) is a severe complication that may follow pars plana vitrectomy (PPV) for diabetic macular edema (DME). The objective of this study was to evaluate the effectiveness of perioperative fluorescein angiography (FA) and targeted photocoagulation of the non-perfused area (NPA) in preventing the occurrence of postoperative NVG.

Effects of kallidinogenase in patients undergoing vitrectomy for diabetic macular edema

To evaluate the effectiveness of the combination of vitrectomy with kallidinogenase for diabetic macular edema (DME). This study was designed as a prospective, randomized, multicenter study comparing 19 eyes of 19 patients who received 150 units of kallidinogenase administered a day for 52weeks from the day after vitrectomy (study group) with 20 eyes of 20 patients who received no kallidinogenase (control group). The main outcome measurements included logMAR visual acuity and central foveal thickness (CFT) before surgery and at 3, 6, 9, and 12months after vitrectomy. During follow-up, 11 patients dropped out (six in the study group and five in the control group), leaving 28 eyes in 28 patients for analysis (13 in the study group and 15 in the control group). Visual acuity improved significantly at 12months in both groups compared with before surgery. The degree of improvement did not differ significantly between the groups. At 12months, the mean CFT decreased significantly in both groups, with no significant difference in the rate of change between the two groups. In the study group, the visual acuity and CFT significantly improved from 3 to 12months and from 6 to 12months, whereas these parameters did not continue to improve in the control group after 6 months (for visual acuity) or 3 months (for CFT). After vitrectomy for DME, visual acuity and CFT improved significantly in both groups, but only patients treated with kallidinogenase continued to have significant improvement throughout the study period.

Foveal Microstructure Analysis in Eyes with Diabetic Macular Edema Treated with Vitrectomy.

The purpose of this study was to evaluate baseline and postoperative factors affecting outcomes after vitrectomy for diabetic macular edema (DME) using optical coherence tomography (OCT). Vitrectomy combined with inner limiting membrane (ILM) peeling and additional laser photocoagulation therapy was performed on 36 eyes of 30 DME patients. Evaluations included the logarithm of the minimal angle of resolution (logMAR), best-corrected visual acuity (BCVA) and OCT parameters at baseline and 1, 3, 6, and 12months postoperatively. Correlations between OCT parameters and BCVA were assessed at each follow-up visit. Correlations among postoperative BCVA and preoperative BCVA, foveal macular thickness (FMT), outer foveal thickness (OFT), and photoreceptor outer segment (PROS) length were evaluated using multiple regression analysis. BCVA significantly improved from 0.50±0.25 to 0.34±0.26 at 12months postoperatively (P<0.001). Mean FMT improved significantly from 526.4±120.4 to 384.6±120.5 at 1month, 325.2±100.3 at 3months, 304.1±102.5 at 6months and 274.2±86.6μm at 12months postoperatively (P<0.001, respectively). OFT 1month after surgery was significantly decreased 46.5±14.7-40.2±14.4μm (P=0.017), although at 3, 6, and 12months it did not differ from the baseline value. PROS length 1month after surgery significantly decreased from 31.7±6.9-28.8±6.8μm (P=0.015) and that at 3months and 6months recovered to the baseline value. PROS length 12months after surgery was significantly increased to 34.3±7.2μm from baseline (P=0.023). Mean FMT was not correlated with BCVA at any time point. Mean OFT and PROS length at 3, 6, and 12months were correlated with BCVA. In multiple regression analysis, PROS length had the greatest effect on VA 12months postoperatively (P=0.0262, standard regression coefficient=-0.366). Current surgery helps DME patients to maintain VA and foveal structures. The results suggest that PROS length predicts visual outcome in DME patients following vitrectomy with ILM peeling and additional laser photocoagulation.

Vitrectomy for Diabetic Macular Edema

Diabetic macular edema (DME) can often be a difficult disease to manage with a subset of patients not improving with existing treatments. As indicated in early studies, patients with hyaloid-retinal traction may benefit the most from vitrectomy for DME. However, some patients without evidence of hyaloid traction may also improve after vitrectomy. It is difficult to predict which patients will improve with surgery. In addition, as treatment options have evolved, the appropriate timing of vitrectomy for DME remains controversial. An improvement in imaging modalities and enhanced understanding of the pathophysiology of the disease may aid in the appropriate use of this treatment option.

Investigation of Pars Plana Vitrectomy for Diabetic Macular Edema

Investigation of Pars Plana Vitrectomy for Diabetic Macular Edema

Vision-related quality of life and visual function following intravitreal bevacizumab injection for persistent diabetic macular edema after vitrectomy.

To investigate the vision-related quality of life (VR-QOL) and visual function in patients undergoing intravitreal injection of bevacizumab (IVB) for persistent diabetic macular edema (DME) after vitrectomy. This institutional study enrolled 20 consecutive patients (20 eyes) who had received 1.25mg IVB for persistent macular edema after vitrectomy for DME at least 3months previously. Visual function and VR-QOL were measured before, and 1 and 3months after IVB. Measurements included the logarithm of the minimum angle of resolution (logMAR), best corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia using M-CHARTS, central retinal thickness using optical coherence tomography, and VR-QOL with the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). One month after IVB, statistically significant improvements were observed in central retinal thickness, letter contrast sensitivity, and the VFQ-25 "mental health" subscale score (P<0.05, Dunnett test). LogMAR BCVA, metamorphopsia, and the VFQ-25 composite score did not improve significantly. Three months after IVB, there were no significant improvements in any parameters examined. Intravitreal bevacizumab injection for persistent DME after vitrectomy temporarily improved central retinal thickness, contrast sensitivity, and the psychometric aspect of the VR-QOL, but these effects did not last for over 3months.

The effect of posterior sub-Tenon's capsule triamcinolone acetonide injection to that of pars plana vitrectomy for diabetic macular edema.

PurposeTo compare the effect of posterior sub-Tenon’s capsule triamcinolone acetonide (STTA) injection to that of pars plana vitrectomy (PPV) for diabetic macular edema (DME).Patients and methodsThe medical records of 50 patients (52 eyes) with DME were reviewed. Twenty-six eyes underwent STTA (20 mg) and the other 26 eyes underwent vitrectomy combined with cataract surgery. The central macular thickness (CMT), measured by optical coherence tomography, and best-corrected visual acuity (BCVA) were determined before and 1, 3, and 6 months after treatment.ResultsThe differences in the BCVA and the CMT between the STTA group and the PPV group were not significant before or at any time after the treatment. In both the STTA and PPV groups, there were significant differences between the pre-treatment CMT and BCVA at any time after treatment.ConclusionWe recommend STTA injection for the treatment of DME.

HYPERREFLECTIVE FOCI IN OUTER RETINA PREDICTIVE OF PHOTORECEPTOR DAMAGE AND POOR VISION AFTER VITRECTOMY FOR DIABETIC MACULAR EDEMA

To investigate the correlation between visual outcomes and preoperative hyperreflective foci in the outer retinal layers seen on spectral domain optical coherence tomography images in eyes that underwent vitrectomy for diabetic macular edema. We retrospectively reviewed 32 consecutive eyes that underwent vitrectomy for diabetic macular edema. Ten eyes had accumulated or many hyperreflective foci in the outer retinal layers preoperatively; 22 eyes did not have the pathology. The logarithm of the minimum angle of resolution and the junction between inner and outer segments were studied in the groups. Logarithm of the minimum angle of resolution was significantly better in eyes without hyperreflective foci than in those with hyperreflective foci at 3 months and 6 months, and the last visit (P = 0.029, 0.010, and <0.001, respectively) compared with no differences at the baseline. Visual improvement was greater in eyes with no hyperreflective foci at the same time points. Seven eyes with hyperreflective foci had no junction between inner and outer segments at the final visit, whereas only 4 eyes with no foci had no junction between inner and outer segments (P = 0.004). However, the foveal thickness did not differ between the groups at any time. Preoperative hyperreflective foci in the outer retinal layers detected by spectral domain optical coherence tomography might predict the photoreceptor damage and a poorer prognosis after vitrectomy for diabetic macular edema.

Vitrectomy for diabetic macular edema: a systematic review and meta-analysis

ObjectiveTo systematically review, and perform meta-analysis on, the available data regarding the efficacy of vitrectomy for diabetic macular edema. DesignSystematic review and meta-analysis of published randomized controlled trial data. MethodsWe searched PubMed and the Cochrane database for randomized, controlled trials investigating vitrectomy for diabetic macular edema. Structural (foveal thickness) and functional (visual acuity) outcomes were used as the primary outcome measures. ResultsEleven studies met the criteria for inclusion in this review: these studies were heterogenous in their experimental and control interventions, follow-up period, and eligibility criteria. Seven studies compared vitrectomy with the natural history of diabetic maculopathy, with laser, or with intravitreal corticosteroid injection. Four studies compared vitrectomy with internal limiting membrane peeling to vitrectomy alone. One of the latter 4 studies was the only to investigate vitrectomy in patients with vitreomacular traction. Meta-analysis suggests a structural, and possibly functional, superiority of vitrectomy over observation at 6 months. Vitrectomy also appears superior to laser in terms of structural, but not functional, outcomes at 6 months. At 12 months, vitrectomy offers no structural benefit and a trend toward inferior functional outcomes when compared with laser. ConclusionsThere is little evidence to support vitrectomy as an intervention for diabetic macular edema in the absence of epiretinal membrane or vitreomacular traction. Although vitrectomy appears to be superior to laser in its effects on retinal structure at 6 months, no such benefit has been proved at 12 months. Furthermore, there is no evidence to suggest a superiority of vitrectomy over laser in terms of functional outcomes.

Axial Length as a Factor Associated With Visual Outcome After Vitrectomy for Diabetic Macular Edema

To investigate whether axial length predicts visual acuity outcome after vitrectomy for diffuse macular edema secondary to diabetic retinopathy. Fifty-one eyes of 41 patients with diabetic macular edema (DME) who underwent vitrectomy were reviewed retrospectively. Clinical data, including axial length measured by partial coherence interferometry, postoperative best-corrected visual acuity (BCVA), and postoperative status of integrity of the photoreceptor layer observed by optical coherence tomography, were recorded. The relationship between axial length and postoperative BCVA or visibility of the junction between the inner and outer segment (IS/OS) line at 12 months after surgery were analyzed. Logistic regression analyses were performed to examine predictors related to postoperative BCVA. Median BCVA improved significantly (P < 0.0001) after surgery (0.4 logMAR units; range, 0-1.5) compared to baseline (0.69 logMAR units; range, 0.22-1.22). Median axial length was significantly longer (P = 0.017) when postoperative BCVA was below 0.4 logMAR units (23.51 mm; range, 22.30-26.10) compared to over 0.4 logMAR units (23.02 mm; range, 22.10-24.65). A significant negative correlation was observed between postoperative logMAR and axial length (n = 51, rs = -0.35, P = 0.012). Median axial length was significantly longer (P = 0.039) in eyes with visible IS/OS line (23.54 mm; range, 22.39-26.10) than in those without visible IS/OS line (23.02 mm; range, 22.13-24.65) at 12 months after surgery. Multivariate logistic regression analysis showed that short axial length (odds ratio: 0.3, P = 0.009) increased the risk of poor visual outcome after surgery. Longer axial length predicts better postoperative BCVA after vitrectomy for diffuse macular edema secondary to diabetic retinopathy.

Macular Migration toward the Optic Disc after Inner Limiting Membrane Peeling for Diabetic Macular Edema

To investigate the papillofoveal distance and its association with retinal thickness on optical coherence tomography (OCT) images after vitrectomy for diabetic macular edema (DME). In this retrospective case series, 72 eyes of 57 consecutive patients who underwent vitrectomy for DME were included. Retinal images dissecting the fovea horizontally were obtained using OCT before and after vitrectomy. After identification of the disc margin and the presumed foveal center, the papillofoveal distance was measured on the OCT images. The association of the distance with retinal thickness and peeling of the inner limiting membrane (ILM) was evaluated. The papillofoveal distance was significantly shorter after vitrectomy (3956.1 ± 299.0 μm vs. 3759.6 ± 331.3 μm; P < 0.001), and the shortening was correlated negatively with the total and inner retinal thickness in the temporal subfield (r = -0.29, P = 0.012 and r = -0.34, P = 0.004, respectively). Shortening of the papillofoveal distance was greater in 54 eyes in which ILM peeling was performed compared with 18 eyes in which ILM peeling was not performed (234.7 ± 159.3 μm vs. -9.7 ± 83.5 μm; P < 0.001). No differences were seen in the papillofoveal distance and retinal thickness before and after surgery between eyes with and without preoperative epiretinal membrane or posterior vitreous detachment. The total and inner thicknesses in the temporal subfield were thinner postoperatively in eyes that underwent ILM peeling than those without ILM peeling (P < 0.001 and P < 0.001). The papillofoveal distance on OCT images was shortened and the retina in the temporal subfield was thinner in eyes that underwent ILM peeling to treat DME.

Segmentational Analysis of Retinal Thickness after Vitrectomy in Diabetic Macular Edema

To measure the inner and outer retinal thicknesses on spectral-domain optical coherence tomography (SD-OCT) and evaluate their association with logMAR after vitrectomy for diabetic macular edema (DME). In this retrospective case series, there were 55 consecutive eyes with DME for which vitrectomy was performed. The total retinal thickness, the inner thickness (from the innermost of the retina to the inner nuclear layer), and the outer thickness (from the outer plexiform layer to the retinal pigment epithelium) in the parafoveal subfields were measured manually, and the association with logMAR was evaluated. The total retinal thicknesses in the central, nasal, and inferior subfields were significantly (r = 0.37, P = 0.005; r = 0.29, P = 0.032; r = 0.33, P = 0.015, respectively) associated with the baseline logMAR; no subfield thickness was correlated with the logMAR at the final visit. However, segmentational analysis showed that the outer retinal thickness of the temporal subfield was associated with disruption of the junction between the inner and outer segments at the fovea (P = 0.021 and P = 0.005) and negatively correlated with the logMAR (r = -0.37, P = 0.006 and r = -0.28, P = 0.042) at the 6-month and final visit. The inner thickness of the nasal subfield did not change after vitrectomy compared with the other subfields and the outer thickness of all subfields in the parafoveal area; the baseline nasal total thickness was correlated most significantly with the logMAR (r = 0.40, P = 0.002 and r = 0.37, P = 0.006) at the 6-month and final visits. Segmentational analysis provided useful information for considering the prognosis and pathogenesis after vitrectomy for DME.

MACULAR THICKNESS CHANGES AFTER PHACOEMULSIFICATION IN PREVIOUSLY VITRECTOMIZED EYES FOR DIABETIC MACULAR EDEMA

To report visual results and anatomical outcome after uncomplicated phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. This retrospective noncomparative study included 22 eyes of 19 diabetic patients who underwent uncomplicated cataract surgery with phacoemulsification and intraocular lens implantation after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema. Main outcome measures included visual acuity and foveal thickness (FT) changes as assessed by optical coherence tomography. Wilcoxon test was used for statistical analysis. Mean follow-up time was 11.9 ± 8.75 months. Mean FT increased by 20.5 ± 67.6 μm (8.4%), with a mean preoperative FT of 237 ± 69 μm compared with a mean postoperative FT of 257.6 ± 89.8 μm (P = 0.236). Foveal thickness increased by at least 20% in 6 eyes (27.3%), remained within 20% in 14 eyes (63.6%), and decreased by 20% in 2 eyes (9.1%). Visual acuity improved by ≥2 lines in 16 eyes (72.7%) and remained stable in 6 eyes (27.3%). Visual acuity was 20/40 or better in 11 eyes (50%). Moderate but insignificant increase in FT was observed after phacoemulsification in eyes that previously underwent pars plana vitrectomy for diabetic macular edema. Prospective studies with a large number of patients are warranted for a more reliable conclusion.

FACTORS ASSOCIATED WITH VISUAL ACUITY OUTCOMES AFTER VITRECTOMY FOR DIABETIC MACULAR EDEMA

To evaluate factors ¶associated with favorable outcomes after vitrectomy for diabetic macular edema. Data were collected prospectively on 241 eyes undergoing vitrectomy for diabetic macular edema. Multivariate models were used to evaluate associations of 20 preoperative and intraoperative factors with 6-month outcomes of visual acuity and retinal thickness. Median central subfield thickness decreased from 412 μm to 278 μm at 6 months, but median visual acuity remained unchanged (20/80, Snellen equivalent). Greater visual acuity improvement occurred in eyes with worse baseline acuity (P < 0.001) and in eyes in which an epiretinal membrane was removed (P = 0.006). Greater reduction in central subfield thickness occurred with worse baseline visual acuity (P < 0.001), greater preoperative retinal thickness (P = 0.001), removal of internal limiting membrane (P = 0.003), and optical coherence tomography evidence of vitreoretinal abnormalities (P = 0.006). No associations with clinician's preoperative assessments of the posterior vitreous were identified. These results suggest that the removal of epiretinal membranes may favorably affect visual outcome after vitrectomy. Preoperative presence of vitreoretinal abnormalities appeared to be associated with somewhat greater reductions in retinal thickness but not with visual acuity outcome. These results may be useful for future studies evaluating vitrectomy for diabetic macular edema.

Vitrectomy Outcomes in Eyes with Diabetic Macular Edema and Vitreomacular Traction

To evaluate vitrectomy for diabetic macular edema (DME) in eyes with at least moderate vision loss and vitreomacular traction. Prospective cohort study. The primary cohort included 87 eyes with DME and vitreomacular traction based on investigator's evaluation, visual acuity 20/63-20/400, optical coherence tomography (OCT) central subfield >300 microns and no concomitant cataract extraction at the time of vitrectomy. Surgery was performed according to the investigator's usual routine. Follow-up visits were performed after 3 months, 6 months (primary end point), and 1 year. Visual acuity, OCT retinal thickening, and operative complications. At baseline, median visual acuity in the 87 eyes was 20/100 and median OCT thickness was 491 microns. During vitrectomy, additional procedures included epiretinal membrane peeling in 61%, internal limiting membrane peeling in 54%, panretinal photocoagulation in 40%, and injection of corticosteroids at the close of the procedure in 64%. At 6 months, median OCT central subfield thickness decreased by 160 microns, with 43% having central subfield thickness <250 microns and 68% having at least a 50% reduction in thickening. Visual acuity improved by > or =10 letters in 38% (95% confidence interval, 28%-49%) and deteriorated by > or =10 letters in 22% (95% confidence interval, 13%-31%). Postoperative complications through 6 months included vitreous hemorrhage (5 eyes), elevated intraocular pressure requiring treatment (7 eyes), retinal detachment (3 eyes), and endophthalmitis (1 eye). Few changes in results were noted between 6 months and 1 year. After vitrectomy performed for DME and vitreomacular traction, retinal thickening was reduced in most eyes. Between 28% and 49% of eyes with characteristics similar to those included in this study are likely to have improvement of visual acuity, whereas between 13% and 31% are likely to have worsening. The operative complication rate is low and similar to what has been reported for this procedure. These data provide estimates of surgical outcomes and serve as a reference for future studies that might consider vitrectomy for DME in eyes with at least moderate vision loss and vitreomacular traction.

Morphometry of surgically removed internal limiting membrane during vitrectomy in diabetic macular edema

Histopathologic and morphometric analysis of the internal limiting membrane (ILM) in diabetic eyes was performed. The thickness of the ILM was correlated with the level of glycosylated hemoglobin (HbA(1C)) and other clinical factors. The prospective study involved 56 eyes of 52 diabetic patients with a mean age of 63 +/- 7.6 years. Vitrectomy with trypan blue-assisted ILM peeling was performed in the standard way. The mean follow-up period was 8.7 months (range 3-19 months). The ILM was fixed immediately after peeling in 2.5% glutaraldehyde and submitted for electron microscopic evaluation. The ILM was photographed at standard magnification (x5,000) with the scale of 1 microm in the shot. Morphometric analysis demonstrated a significant thickening of the ILM in all eyes, with a mean thickness of the ILM of 3.61 +/- 1.22 microm. It was found that a higher thickness of the ILM is related to elevated HbA(1C) in both types of diabetes mellitus (DM) (p = 0.040). We also found significant dependence of ILM thickness in relation to duration of DM by comparison of men and women (p = 0.026), and a significant correlation between ILM thickness and the age of diabetic patients related to their gender (p = 0.029). We confirmed increased thickness of the surgically peeled ILM and statistically significant correlations to elevated HbA(1C) in both types of DM, and to further clinical characteristics of case series. Morphometric and histopathologic analyses of the ILM contribute to more objective evaluation of the ultrastructure of the vitreomacular interface.

The vitreo-retinal interface in macular diseases

Anomalous posterior vitreous detachment occurs, when the extent of vitreous liquefaction exceeds the degree of weakening of vitreo-retinal adherence and traction is exerted at the vitreo-retinal interface. In the macular region vitreo-macular traction is obviously correlated with macular disorders like macular pucker, epiretinal membrane, macular hole formation, and vitreo-macular traction syndrome. The pathogenesis of diabetic macular edema and exudative age-related macular degeneration is more complex. However, the effectivity of vitrectomy in diabetic macular edema and high incidence of vitreoretinal adhesions in exudative age-related macular degeneration underscore the important role of the vitreous in the pathogenesis of these diseases.

Triamcinolone-Assisted Removal of Internal Limiting Membrane Enhances the Effect of Vitrectomy for Diabetic Macular Edema

Purpose: To evaluate the efficacy of internal limiting membrane (ILM) peeling during vitrectomy to treat diabetic macular edema (DME). Methods: In this nonrandomized study, we retrospectively analyzed the medical charts of 107 eyes that had undergone three-port vitrectomy to treat DME. The ILM was peeled in 65 eyes and not peeled in 42 eyes (ILM ON group). Indocyanine green (ICG) was used on 36 eyes (ICG group) and triamcinolone acetonide (TA) on 29 eyes (TA group) to make the ILM more visible. Results: In all groups, the mean foveal thickness was significantly decreased after surgery. Visual acuity (VA) improved gradually after the surgery and was significantly better than the preoperative VA at 6 months in the ICG group and at 3 months in the TA group. Compared with the ILM ON group eyes, the eyes in the TA group had significantly better improvement of VA. Conclusion: TA-assisted ILM peeling may improve the VA outcome to treat DME.