VITRECTOMY IN SEVERE MACULAR EDEMA

Johann Roider (Regensburg)

Treatment of cystoid or severe macula edema is difficult. Vitrectomy is a novel approach in treatment of macular edema.

Patient and methods: Between 1998 - 2001 thirty patients with severe macular edema had been treated by vitrectomy. 22 patients had cystoid edema, as shown by fluorescein angiography. Average age was 63,8 ± 12,8 years. Reasons for macular edema were as follows: diabetes n=11, uveitis n =5, Irvine-Gass syndrome n=5 and miscancellous n=9. Follow-up period was: > 3 months: n=20, < 3 months: n=10. The average visual acuity was 0,25 ± 0,13. In all cases fluorescein angiography was performed pre- and post surgery in 7 cases OCT was performed before and after surgery. Histology of the inner limiting membrane (ILM) had been performed in selected cases.

Results: In all cases a posterior vitreous detachment was performed. In 17/30 cases ILM peeling was done, in 10 cases an epiretinal membrane was removed, in 2 cases both were removed and in 1 case no peeling was performed. Complications were as follows: detachment of the retina 1/30 (after 6 weeks), ruptured cyst 1/30, anterior ischemic ophthalmopathia 1/30. Visual acuity (> 3months) was better in 13/20, unchanged in 3/20 and worse in 4/20. The average visual acuity was 0,32 ± 0,18. In 13/20 cases edema was less and in 2/20 more. OCT findings were in correlation with the angiographic findings. Electronmicroscopy of the ILM confirmed the typical findings of a basal membrane with no collagen varying in thickness between 1,5 to 3 µm.

Conclusion: Vitrectomy in severe macula edema seems useful.


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