Improvement of visual acuity in eyes with diabetic macular edema after treatment with pars plana vitrectomy

Abstract

Background: Diabetic macular edema (DME) is the leading cause of severe visual loss in patients with diabetic retinopathy. This is so despite the fact that argon laser photocoagulation of the macula (M-ALC) has been shown to be beneficial. Recently, it has been suggested that pars plana vitrectomy (PPV) can lead to the resolution of DME and stop the deterioration of central visual acuity.

Purpose: To explore the potential benefit of PPV for the treatment of DME.

Patients and methods: PPV was carried out in 30 eyes of 21 consecutive patients (median age 71 years, range 61-88 years) with type II diabetes mellitus suffering from DME. 23 eyes had non-proliferative diabetic retinopathy (NPDR) and 7 eyes had proliferative diabetic retinopathy (PDR) in addition to DME. Posterior vitreous detachment had to be carried out in all cases. If epiretinal membranes were present (23 eyes), they were removed. In 13 eyes (initially 11 eyes) the internal limiting membrane (ILM) was also removed. Prior to PPV 8 eyes had received M-ALC. Three eyes had M-ALC after PPV. One eye developed a retinal detachment 6 weeks after PPV and was excluded form the analysis. After an initial treatment failure two eyes underwent repeat PPV with peeling of the ILM. Both eyes of another patient had 2 repeat PPVs because of recurrent vitreous hemorrhage. Median follow-up was 16 months (range 1-62 months).

Results: Following PPV the macula flattened or became attached in 20/27 (74%) eyes. 15/18 (83%) eyes showed reduction or disappearance of leakage during fluorescein-angiography. Central visual acuity increased by two to six lines in 15/27 (56%) for the whole group at 6 months after PPV. For the subgroup (18 eyes) for which the evolution of visual acuity prior to PPV could be documented mean and median visual acuity had decreased markedly from 0.26 +/- 0.19 resp. 0.2 (range 0.03-0.6) to 0.12 +/- 0.09 resp. 0.1 (range 0.02-0.4) during the 12 months preceding PPV and increased to 0.28 +/- 0.23 resp. 0.2 (range 0.03-0.8) during the 12 months following PPV.

Conclusion: PPV almost always results in a reduction and often complete disappearance of DME as evidenced by ophthalmoscopy and fluorescein-angiography. Most importantly, central visual acuity often increases, sometimes to a very large extent with dramatic improvement in quality of life of the patients.