Role of pars plana vitrectomy with internal limiting membrane peel in patients of refractory diabetic macular edema

Yasir Afzal, Asad Aslam Khan, Nasir Chaudhary, Irfan Qayyum

Abstract


Objective: To see the role of pars plana vitrectomy (PPV) with Internal Limiting Membrane (ILM) peel in patients of refractory diabetic macular edema in reducing central macular thickness.

Introduction: Diabetic macular edema (DME) is a major cause of visual morbidity in diabetic patients. Vitrectomy for DME has seemingly gained rapid, widespread acceptance but studies evaluating the efficacy of vitrectomy (with or without ILM peeling) have yielded conflicting results. The role of Internal Limiting Membrane (ILM) peeling in the treatment of DME is also controversial, and sufficient data to clarify its role have not yet been available.

Study Design: Quasi experimental study.

Place & Duration of Study: Vitreo retina clinic, Department of Ophthalmology, Mayo Hospital Lahore.

Methodology: Pre-operatively, Central Macular Thickness (CMT) was measured with Optical Coherent Tomogram (OCT). OCT was performed with a standard protocol of 6mm radial scan centered at patient’s fovea. All patients underwent 23G Pars plana Vitrectomy (PPV) by single surgeon. After completing vitrectomy and fluid-air exchange, ILM was stained with brilliant blue G for 4 to 5 minutes. ILM peeling was done in all twenty cases with iatrogenic macular hole formation in two cases and retinal bleeding in vitreous cavity in three cases. Patients were followed up till 3 months postoperative. Post-operatively central macular thickness was measured by OCT after one month and three months respectively.

Results:. Preoperative mean CMT of patients was 439.35±103.82. At 1st month post-operative it was 266.00±81.51 and at 3rd month post-operative it was 254.00±85.32. The decrease in CMT post operatively at 3rd month is statistically significant.

Conclusion: Pars plana vitrectomy with ILM peel has significant role in reducing refractory diabetic macular edema.

Key words: Refractory Diabetic macular edema, Central macular thickness, Pars plana vitrectomy, Internal limiting membrane peel

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References


Yamamoto T, Hitani K, Sato Y, Yamashita H, Takeuchi S. Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Ophthalmologica 2005;219:206

Dillinger P, Mester U. Vitrectomy with removal of the internal limiting membrane in chronic diabetic macular oedema. Graefes Arch Clin Exp Ophthalmol 2004;242:630-7.

Jahn CE, Töpfner von Schutz K, Richter J, Boller J, Kron M. Improvement of visual acuity in eyes with diabetic macular edema after treatment with pars plana vitrectomy. Ophthalmologica 2004;218:378-84.

Yanyali A, Horozoglu F, Celik E, Ercalik Y, Nohutcu AF. Pars plana vitrectomy and removal of the internal limiting membrane in diabetic macular edema unresponsive to grid laser photocoagulation. Eur J Ophthalmol 2006;16:573-81.

Park JH, Woo SJ, Ha YJ, Yu HG. Effect of vitrectomy on macular microcirculation in patients with diffuse diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 2009;247:1009-17

Gandorfer A, Messmer EM, Ulbig MW, Kampik A. Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina 2000;20:126-33.

Kamura Y, Sato Y, Isomae T, Shimada H. Effects of internal limiting membrane peeling in vitrectomy on diabetic cystoid macular edema patients. Jpn J Ophthalmol 2005;49:297-300.

Hartley Kl, Smiddy We, Harry W Flynn Jr, Murray TG. Pars plana vitrectomy with internal limiting membrane peeling for diabetic macular edema. Retina. 2008 Mar 1;28(3):410-9

Raizada S, Al Kandari J, Al Diab F, Al Sabah K, Kumar N, Mathew S. Pars plana vitrectomy versus three intravitreal injections of bevacizumab for nontractional diabetic macular edema. A prospective, randomized comparative study. Indian journal of ophthalmology. 2015 Jun 1;63(6):504.

Patel JI, Hykin PG, Schadt M, Luong V, Fitzke F, Gregor ZJ. Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina 2006;26:5–13.

Dehghan MH, Salehipour M, Naghib J, Babaeian M, Karimi S, Yaseri M. Pars plana vitrectomy with internal limiting membrane peeling for refractory diffuse diabetic macular edema. Journal of ophthalmic & vision research. 2010;5(3):162-7.

Mochizuki Y, Hata Y, Enaida H, Yoshiyama K, Miyazaki M, Ueno A, et al. Evaluating adjunctive surgical procedures during vitrectomy for diabetic macular edema. Retina2006;26:143-148.

Kumagai K, Ogino N, Furukawa M, Demizu S, Atsumi K, Kurihara H, et al. Internal limiting membrane peeling in vitreous surgery for diabetic macular edema. Nippon Ganka Gakkai Zasshi 2002;106:590-594.