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Internal Limiting Membrane Removal in Chronic Diabetic Macular Edema
1Dillinger P., 2Mester U.,
1Augenklinik der Bundesknappschaft (Sulzbach/Saar)
2Bundesknappschaft Sulzbach/Saar, Augenklinik (Sulzbach/Saar)
Purpose: To assess the effect of pars-plana vitrectomy including peeling of the internal limiting membrane (ILM) on the resolution of chronic diabetic macular edema.
Methods: We performed a prospective evaluation of 50 eyes of 46 patients with chronic diabetic macular edema who underwent pars-plana vitrectomy with ILM-removal. All patients had a history of macular edema with severe loss of vision (0.4 or less) of at least 6 months. Grid-laserphotocoagulation had been performed previously 47 eyes. Eyes with significant loss of the foveal capillary net were excluded. Mean follow up was 3.0 months.
Results: Fluorescein angiography revealed partial or complete resolution of the macular edema in all eyes. Mean visual acuity improved from 0.16 preoperatively to 0.25 postoperatively. 17 eyes (32 %) gained 2 or more lines of vision, 4 eyes (8%) lost 2 lines.
Conclusions: Pars-plana vitrectomy with ILM-peeling reduced macular edema in all cases. In contrast, visual acuity improved significantly in one third of the treated eyes only. The discrepancy between anatomical and functional results of ILM-removal in chronic diabetic macular edema is likely to be caused by structural changes of the macula according to the duration of macular edema.