Pars Plana Vitrectomy with Internal Limiting Membrane Peeling and Intravitreal Bevacizumab Injection for Refractory Diffuse Diabetic Macular Edema

Abstract Purpose: Evaluating the impact of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and intravitreal bevacizumab (IVB) injection to manage refractory diffuse diabetic macular edema (DME).Methods: In the current prospective interventional clinical study, eyes with refractory diffuse DME with no response to a minimum of three times IVB injections, and best corrected visual acuity (BCVA) of equal or more than 20/200 and equal or lower than 20/60 were subjected to PPV with ILM peeling and intravitreal avastin injection. Pre- and post-operative assessments were a comprehensive ophthalmologic evaluation, fluorescein angiography, and optical coherence tomography (OCT). BCVA, central macular thickness (CMT) and contrast sensitivity (CS) were major outcomes. Results: Fifteen eyes of 13 cases (mean age: 63±5.19 (range, 54-70) years) were subjected to operation and a follow-up of 3 months. Average BCVA at last test was 0.74 ± 0.19 LogMAR that showed no improvement compared with its value before intervention (0.84 ± 0.14 LogMAR) (P=0.073). Average CMT at last test was 328.26±129 µm that was significantly lower compared with its value before operation (450.8±114 µm) (P=0.002) and a significant improvement in CS was found (from 16.66 ± 8.99 mm to 18.13 ±1.22mm;p=0.003). CMT and BCVA (correlation coefficient =0.419,p=0.120), BCVA and CS (correlation coefficient =-0.336,p=0.221) , and CS and CMT (correlation coefficient =-0.07,p=0.979) were found with no significant correlation. Conclusion: PPV with ILM peeling and IVB regarding refractory diffuse DME reduced macular width along with CS improvement, but does not significantly improve visual acuity.

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Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Nontractional Diabetic Macular Edema

The Open Ophthalmology Journal ◽

10.2174/1874364101711010005 ◽

2017 ◽

Vol 11 (1) ◽

pp. 5-10 ◽

Cited By ~ 6

Author(s):

Jan Niklas Ulrich

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Central Macular Thickness ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Pars Plana

Background: Diabetes mellitus remains the leading cause of blindness among working age Americans with diabetic macular edema being the most common cause for moderate and severe vision loss. Objective: To investigate the anatomical and visual benefits of pars plana vitrectomy with inner limiting membrane peeling in patients with nontractional diabetic macular edema as well as correlation of integrity of outer retinal layers on spectral domain optical coherence tomography to visual outcomes. Methods: We retrospectively reviewed the charts of 42 diabetic patients that underwent vitrectomy with internal limiting membrane peeling for nontractional diabetic macula edema. The integrity of outer retinal layers was evaluated and preoperative central macular thickness and visual acuity were compared with data at 1 month, 3 months and 6 months postoperatively. The student t-test was used to compare the groups. Results: 31 eyes were included. While no differences were seen at 1 and 3 months, there was significant improvement of both central macular thickness and visual acuity at the 6 months follow up visit compared to preoperatively (357, 427 microns; p=0.03. 20/49, 20/82; p=0.03) . Patients with intact external limiting membrane and ellipsoid zone had better preoperative vision than patients with outer retinal layer irregularities (20/54, 20/100; p=0.03) and greater visual gains postoperatively (20/33, p<0.001 versus 20/81; p=non-significant). Conclusion: Pars plana vitrectomy with internal limiting membrane peeling can improve retinal anatomy and visual acuity in patients with nontractional diabetic macular edema. Spectral domain optical coherence tomography may help identify patients with potential for visual improvement.

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Evaluation of Macular Changes in Long Term Period Following Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Diabetic Macular Edema

Ophthalmologica ◽

10.1159/000514992 ◽

2021 ◽

Author(s):

Betul Onal Gunay ◽

Gurkan Erdogan

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Pars Plana Vitrectomy ◽

Internal Limiting Membrane ◽

Additional Treatment ◽

Final Visit ◽

Ilm Peeling ◽

Pars Plana

Aim: To evaluate long term macular changes following pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for diabetic macular edema (DME) Methods: Forty eligible eyes of 37 patients were included in this retrospective study. Best corrected visual acuity (BCVA), central macular thickness (CMT) and 5-mm macular volume (5-MV) were examined preoperatively and at postoperative 1st, 2nd, 3rd, 6th, 12th, 24th months and final visits. Response to surgical treatment was considered as recurrence, reincrease and recovery of DME based on macular changes. Results: Mean follow-up time was 51.1±19.0 months following surgery. Recurrence (n=5) and reincrease (n=17) of DME was observed in 22 eyes (55%) and additional treatments were applied. Recovery of DME was observed in 18 eyes (45%). Preoperative and final visit mean BCVAs (logMAR) were 1.08±0.37 and 0.93±0.45, respectively (p=0.02). Preoperative and final visit mean CMTs were 514.74±155.65 µm and 281.87±112.58 µm, respectively (p<0.001). The 5-MV significantly decreased following surgery (8.18±1.57 mm3 to 6.52±1.39 mm3) (p<0.001). DME was present in 12 eyes (%30) at final visit. Conclusion: Although PPV with ILM peeling had an efficacy in DME management, this effect tends to decrease over time such that considerable amount of patients required additional treatment.

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Visual And Anatomical Outcomes of Pars Plana Vitrectomy in Refractory Diabetic Macular Edema

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i1.995 ◽

2020 ◽

Vol 36 (1) ◽

Author(s):

Hussain Ahmad Khaqan ◽

Usman Imtiaz ◽

Husnain Muhammad Bukhsh ◽

Hafiz Ateeq ur Rehman ◽

Raheela Naz ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Pars Plana Vitrectomy ◽

Visual Assessment ◽

Macular Thickness ◽

Ilm Peeling ◽

Refractory Diabetic Macular Edema ◽

Pars Plana ◽

Anatomical Outcomes

Purpose: To find the visual and anatomical outcomes of pars plana vitrectomy in cases of refractory diabetic macular edema. Study Design: Quasi Experimental study. Place and Duration of Study: Department of Ophthalmology, Lahore General Hospital from January 2013 to April 2019. Material and Methods: Seventy-six patients between the age of 18 and 60 years of both genders having refractory diabetic macular edema with macular thickness of 400 micrometers or more on OCT were enrolled. Informed consent was taken. Detailed preoperative workup including visual assessment, examination on slit lamp using 90D or 78D lens for assessment of macular edema and OCT was done. Patients underwent pars plana vitrectomy, ERM, and ILM peeling. Visual assessment and macular thickness was recorded 4 weeks after surgery. Results: This study included 76 patients with the mean age of 48.15 ± 8.16 years. Patients were further categorized according to age into 2 groups. The gender distribution of patients showed that most of the participants were female in this study. Mean duration of Diabetes Mellitus was 9.95 ± 6.29 years. Most of the patients did not have previous history of laser and only three patients (3.9%) did not receive Intravitreal Anti-VEGF. Mean preoperative visual acuity was 0.44 ± 0.13 while postoperative visual acuity was 0.876 ± 0.18 (P = 0.000). Similarly, significant decrease in macular thickness was observed after the procedure (P = 0.000). Conclusion: Pars plana vitrectomy, ERM and ILM peeling can be an effective treatment option for refractory diabetic macular edema.

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