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Volume 4 No. 2, April 2009 |
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Evaluation of Parsplana Vitrectomy (PPV) and Internal Limiting Membrane (ILM) Peeling in Treatment of Refractory Diabetic Macular Edema Mamdouh M. Kabeel, Ashraf M. El-Batarny, Mohamed K. Tameesh & Ahmad M. Ghonaim
Ophthalmology Department, Faculty of Medicine, Tanta University,
Egypt
Background/Aim: Diabetic Macular Edema (DME) is the major cause
of visual impairment among diabetics. The visual impairment from
persistent macular edema often leads to illegal blindness and has a
significant effect on the quality of life. The ETDRS established
laser photocoagulation as the mainstay of treatment. Despite
appropriate treatment, however 15% of all patients in the ETDRS
experienced visual loss of at least 3 lines after 3 years. Various
authors have reported the use of vitrectomy in cases of DME both
with and without obvious abnormality of the vitreo-retinal
interface. Patients & Methods: This study is a retrospective
evaluation of 14 cases of persistent DME treated with standardized
vitrectomy, Posterior hyaloids removal and ILM peeling at the same
time in the past 2 years. Best corrected visual acuity (BCVA),
Fluorescein Angiography (FA), and macular thickness by optical
coherence tomography (OCT) was the standard methods for evaluation.
Results: In this study, we included 14 eyes of 14 patients with a
persistent DME that lasts for more than 3 months. The age of the
patients ranges from 28-64 with a mean of 47.9±11.77. Among these 14
patients, 8 were males representing 57% and 6 were females
representing 43 %. All of the patients had proliferative diabetic
retinopathy treated before by panretinal photocoagulation in all
patients except for 2 patients that represented by DME only. Only 1
patient was pseudophakic (7%) at the time of treatment and the 13
eyes (93%) were phakic. By comparing the pre-operative visual acuity
to the final post-operative visual acuity at 6 months, there was
statistical significant difference as P<0.001 and from observation
in this series, we found that 11 eyes (78.6%) experienced an
improvement in their final post-operative visual acuity and only 3
eyes (21.4%) experienced the same pre-operative vision at 6 months
post-operatively. And by comparing the pre-operative CFT to the
final CFT at 6 months post-operatively, there was statistically
significance as P<0.001. We noticed that all 14 patients (100%)
experienced a steady improvement of their CFT post-operatively that
was not necessarily correlated to the final BCVA. Conclusion:
Parsplana Vitrectomy with ILM removal in addition to the posterior
hyaloid removal will help in curing most of the refractory DME cases
that was resistant to either laser or intravitreal therapy of
triamcinolone or anti-angiogenesis and also, the pre-operative time
of this edema is of value, as less edema time favor good prognosis. |
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