Original scientific paper
Chronic Diabetic Macular Oedema, Pars Plana Vitrectomy or Combination of PPV and Laser?
Svatopluk Synek
Monika Synkova
Abstract
Diabetic cystoid macular oedema (DME) is a common cause of visual acuity (VA) decrease. Good anatomical results
and VA of pars plana vitrectomy (PPV) in cases of macular hole internal limiting membrane (ILM) peeling leads to usage
of this technique in DME. A favorable result even in a case without vitreoretinal traction leads to conclusion that pathogenesis
of this disease is different. We analyzed retrospectively 20 eyes from 20 patients with DME that had undergone
PPV and ILM peeling. Half of them were laser treated 6 months before surgery. All eyes had an attached posterior hyaloids
membrane in the macular region, but without thickening and without traction. Median duration of DME at the
time of PPV was 18 months (range 12–24 months). The median preoperative best-corrected VA of 0.4 (range 0.01–1.0),
improved to a median postoperative VA of 0.55 (range 0.01–1.0). Ten eyes without preoperative laser coagulation had a
median VA improvement of 77%, while 10 eyes with preoperative macular laser treatment had a median VA improvement
of 14.8%. In all 20 eyes DME was no longer visible on microscopic examination after a median period of 3 months after
PPV. PPV and ILM peeling resulted in the resolution of oedema, with an improvement in VA in the majority of cases.
Eyes without preoperative macular photocoagulation had a significantly higher visual improvement than eyes with preoperative
laser treatment. A randomized controlled prospective trial of PPV versus laser is needed to determine the role of
PPV as a treatment modality for DME.
Keywords
pars plana vitrectomy; diabetic macular oedema; mental insanity; internal limiting membrane peeling
Hrčak ID:
34530
URI
Publication date:
1.10.2008.
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