DIABETIC MACULAR EDEMA UPDATE IN SURGICAL TREATMENT

Borjá F. Corcostegui (Barcelona)

Diabetic macular edema is a major cause of visual loss in diabetic retinopathy. The possible causes are retinal hypoxia, increased vascular permeability, breakdown of outer blood-retinal barrier, traction of thickened posterior hyaloid membrane and for internal limiting membrane. Surgical damage by laser or anterior segment surgery. Conventional treatments are focal laser photocoagulation, grid-pattern laser treatment.

Rational for vitrectomy for diabetic Macular Edema: Remove the tangential traction, improving of diffusion internal barrier, improvement of oxygen supply, drenage of intraretinal fluid and/or hard exudates it is an optional manouver.

Major inclusion criteria for vitrectomy are: A persistent diffuse macular edema with or without PVD. Macular Edema with poor answer to focal o modified grid-pattern laser treatment. Clinical evaluation include visual acuity (ETDRS chart), constrast sensitivity, fluorescein angiography, slit-lamp biomicroscopy and optical coherence tomography (OCT).

The surgical technique: Three ports pars plana vitrectomy dissection or PVD and then staining ILM with ICG. Removal of ILM using proper forceps. Microretinotomy for acces to subretinal space and aspiration of fluid and hard exudates. Panretinalphotocoagulation is completed.

Anatomical results: Decrease retinal thickeness within 3 - 6 months. Resolution of edema 85 % case in the first year. Visual improvement 50 % of cases, they on depend of the previous visual acuity and thickness of the macula. Visual improvement may not correlate with edema resolution. Surgical complications are the same of diabetic vitrectomy; cataract, retinal detachment, neovascular glaucoma, and others.


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