ILM removal in diabetic macula edema
Horst Helbig (St. Gallen)
ILM-removal is a new therapeutic strategy for the treatment of diabetic
macular
edema. In this talk a sceptical point of view is taken and arguments
against ILMpeeling
for routine treatment of diabetic macular edema are summarized. Laser
treatment is still the gold standard for the treatment of diabetic
macular edema and
proven effective for all forms of macular edema except ischemic maculopathy.
Only
eyes unresponsive to laser treatment should be considered to be cadidates
for ILMpeeling.
Eyes with visible traction on the macula benefit from removing tractional
forces without ILM-removal. Available studies present no convincing
randomized data
that ILM-removal does indeed improve the clinical course. Data from
uncontrolled studies may be biased by
simultaneous effects of the surgery such as removal of media opacities,
endolaser or removal of tractional membranes.
The possible positive effects of ILM-peeling should be weighed against
the proven risks of vitrectomy
with ILM-peeling such as retinal detachment, damage to macular cysts
during ILM-peeling and development of
cataracts.