VITRECTOMY FOR DIABETIC MACULAR EDEMA

Gerhard F. Kieselbach (Innsbruck)

Macular edema is the most common cause of visual loss among diabetics. Over a 10-year period the incidence of diabetic macular edema (ME) is between 13.9 % and 25.4 %. After 16 years of ETDRS guidelines a great number of patients with ME remains with poor vision despite of intensive lasertreatment. Since 1992 a growing number of publications shows the benefit of vitrectomy on diabetic macular edema. Also in our consecutive study of 48 patients a visual benefit in nearly 58 % could be observed. Several investigators described a relationship between posterior vitreous attachment and the presence of ME. Also macular traction and macular detachment, detected by optical coherence tomography, is associated with ME. Some authors suggest a relationship between several growth factors and the presence of ME. A recent study, published this September in the AMO suggests a general effect of vitrectomy in reducing ME, which depends not on the presence or absence of posterior vitreous detachment. This observation cannot be confirmed by our results. Unfortunately up to now no data from randomised clinical studies are available, but current evidence suggests a major role of the vitreous in the pathology of diabetic macular edema. Based on the available studies and our own experience vitrectomy can be recommended in eyes with macular edema despite of former lasertreatment and attached and thickened vitreous, macular traction or detached macular. In all cases we highly recommend following the guidelines of the ETDRS first.


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