Is immediate treatment necessary for diabetic macular edema after pars plana vitrectomy for tractional complications of proliferative diabetic retinopathy?

Int Ophthalmol. 2021 Nov;41(11):3607-3614. doi: 10.1007/s10792-021-01923-w. Epub 2021 Jun 25.

Abstract

Purpose: To assess the treatment benefit of eyes with diabetic macular edema (DME) in vitrectomized eyes for tractional complications of proliferative diabetic retinopathy (PDR).

Methods: In a retrospective multicentre observational study in India, the clinical outcomes of eyes with center-involving DME in vitrectomized eyes for tractional complications of PDR in people with type 2 diabetes with at least 12 months follow-up data were assessed. The DME status and visual acuity outcomes were compared between those who received treatment versus those observed.

Results: In the 10-year study period, 45 eyes of 44 patients from 5 tertiary centers in India met the inclusion criteria. Center-involving DME was documented after a mean of 7 ± 7 months following pars plan vitrectomy (PPV) for tractional complications of PDR. More than half of the (n = 25) eyes were immediately treated for DME, and treatment was deferred for the rest. At one year, there was a statistically significant reduction in mean central subfield thickness in treated (467.9 ± 124.8 μm to 367.8 ± 143.7 μm; p < 0.001) as well as observed (405.2 ± 132.6 μm to 325.6 ± 149 μm; p < 0.001) eyes, and the change was comparable (p = 0.574). The change in vision was also comparable (0.12 ± 0.31 and 0.22 ± 0.54 Log MAR in the treated and observed group, respectively; p = 0.443).

Conclusion: Treatment for pre-existing or new-onset DME after PPV for tractional complications of PDR may be deferred for up to one year because the DME may resolve spontaneously with time.

Keywords: Diabetes Mellitus; Diabetic Macular Edema; Pars Plana Vitrectomy; Proliferative Diabetic Retinopathy.

Publication types

  • Observational Study

MeSH terms

  • Diabetes Mellitus, Type 2* / complications
  • Diabetic Retinopathy* / complications
  • Diabetic Retinopathy* / diagnosis
  • Diabetic Retinopathy* / surgery
  • Humans
  • Macular Edema* / diagnosis
  • Macular Edema* / etiology
  • Macular Edema* / surgery
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Vitrectomy