ILM-removal in diabetic macular edema
Ulrich Mester, P. Dillinger (Sulzbach)
Purpose: To assess the effect of pars plana vitrectomy including peeling
off the internal
limiting membrane (ILM) on the resolution of chronic diabetic macular
edema.
Methods: We performed a prospective evaluation of 60 eyes of 55 patients
with
chronic diabetic macular edema who underwent pars plana vitrectomy
with ILMremoval.
All patients had a history of macula edema with severe loss of vision
(0.4 or
less) of at least 6 months. In most of the eyes, grid laser photocoagulation
had been
performed previously. Eyes with further vitreoretinal pathologies like
vitreous hemorrhage,
evident macular traction or significant loss of the foveal capillary
net were
excluded. Mean follow up was 3.0 months.
Results: Fluorescein angiography revealed partial or complete resolution
of the macular edema in 55 (93%)
eyes. Mean visual acuity improved from 0.11 preoperatively to 0.18
postoperatively. 26 eyes (43%) gained 2 or
more lines of vision, 4 eyes (7 %) lost 2 lines.
Conclusion: Pars plana vitrectomy with ILM-peeling reduced macular
edema in most cases. In contrast, visual
acuity improved significantly in 43 % of the treated eyes only. The
discrepancy between anatomical and functional
results of ILM-removal in chronic diabetic macular edema is likely
to be caused by structural changes of
the macula according to the duration of macular edema.