29. Long-term Outcomes of Vitrectomy for Diabetic Macular
Edema
Tarek S. Hassan (Royal Oak)
Purpose: To assess the long-term visual and angiographic outcomes of eyes that underwent
vitrectomy for treatment of diabetic macular edema.
Methods: Medical records of patients who underwent vitrectomy for diabetic macular edema
were retrospectively reviewed. Only patients with greater than 30 months of follow-up were
included. Studied variables included Snellen visual acuity (VA), status of macular edema by
clinical exam, and fluorescein angiographic (FA) and OCT findings. The need for additional
postoperative interventions was also assessed.
Results: A total of 45 eyes from 38 patients met the inclusion criteria. The mean age was
67 years, duration of symptoms was 17 months, and follow-up was 56 months (range, 31 to 94).
Thirty-seven eyes (83 %) received laser photocoagulation (mean number of treatments = 2) before undergoing vitrectomy.
The mean preoperative VA was 20/150, best postoperative VA was 20/60, 2 year postoperative VA was 20/80, and VA at the
latest follow-up visit was 20/100. While all of the eyes experienced stable or improved vision at some point during their
follow-up, at the last follow-up visit, 33 eyes (74 %) experienced stable or improved vision and 12 eyes (26 %) lost vision.
The macular edema resolved in 74 % of eyes by postoperative clinical examination, with the mean duration of having a dry
clinical exam being 50 months. Pre- and post-operative FAs were available for 27 eyes, with 15 eyes (56 %) showing
improved or resolved macular edema postoperatively. During follow-up, 13 eyes (29 %) required additional laser photocoagulation,
6 eyes (14 %) required intravitreal triamcinolone, and 3 eyes (7 %) underwent additional vitrectomy. The most
common causes of long-term vision loss occurring after initial improvement were the development of macular ischemia
(59 %), optic nerve ischemia (45 %), persistent/recurrent CSDME (31 %), and fibrotic macular scar (17 %).
Conclusions: Vitrectomy can provide long-term stabilization or improvement of visual acuity in patients with diabetic macular
edema. However, ischemia of the macula and optic nerve commonly led to progressive vision loss in the long-term, and
some patients required additional interventions postoperatively.