Korean J Ophthalmol.  2007 Sep;21(3):146-150. 10.3341/kjo.2007.21.3.146.

Evaluation of the Efficacy of Vitrectomy for Persistent Diabetic Macular Edema and Associated Factors Predicting Outcome

• Song SJ
• Sohn JH
• Park KH

• KMID: 1099029
• DOI: http://doi.org/10.3341/kjo.2007.21.3.146

Abstract

PURPOSE: To evaluate the efficacy of vitrectomy for persistent diabetic macular edema after laser photocoagulation or intravitreal triamcinolone injections and to determine the demographic and ocular factors that influence functional and anatomical outcomes. METHODS: We retrospectively evaluated 55 eyes (51 patients) that had persistent diffuse macular edema after laser photocoagulation or intravitreal triamcinolone injections. We compared preoperative and postoperative best corrected visual acuity and macular thickness by Optical Coherence Tomography and investigated factors including patient's age, presence of vitreomacular traction, grade of diabetic retinopathy, and intraoperative internal limiting membrane removal that may influence the surgical results. RESULTS: The mean preoperative BCVA (log MAR) was 0.91+/-0.40 (0.8-1.2). The BCVA improved to 0.72+/-0.39 (0.3-1.2). The mean preoperative macular thickness was 440+/-130 (202-805) micrometer and the mean macular thickness decreased to 306+/-97 (136-580) micrometer postoperatively. The eyes showed statistically significant improvement in BCVA and central macular thickness (p<0.001). Preoperative better BCVA was associated with an improved postoperative visual acuity. (p=0.04). No other covariates were found to be statistically significant factors for prognosis of postoperative BCVA. CONCLUSIONS: In eyes with persistent diabetic macular edema after laser or IVTA injections, vitrectomy was effective for decreasing macular thickness and improvement of vision. The visual improvement after vitrectomy was associated with the preoperative better BCVA.

Keyword

Diabetic macular edema; Vitrectomy

MeSH Terms

Adult
Aged
Diabetic Retinopathy/*surgery/therapy
Female
Humans
Injections
Laser Coagulation
Macular Edema/*surgery/therapy
Male
Middle Aged
Retreatment
Retrospective Studies
Treatment Outcome
Triamcinolone/administration & dosage/therapeutic use
*Vitrectomy
Vitreous Body

Figure

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  Fig. 1 Pre- and postoperative best corrected visual acuity (Log MAR). BCVA: Best corrected visual acuity.

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  Fig. 2 Fundus photography and fluorescein angiography of 60 year old female patient. Preoperative fundus photography (A) shows hard exudates within the macula and diffuse macular edema, and fluorescein angiography (C) shows diffuse intraretinal and subretinal leakage of fluorescein dye. Fundus photography (B) and fluorescein angiography (D) taken at three month after the operation show resolved macular edema and reduced fluorescein leakage. Visual acuity improved from 0.7 to 0.5 (LogMAR).

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  Fig. 3 Preoperative OCT scan (A) shows diffuse macular thickening of 505 µm. Postoperative OCT scan (B) performed 3 months after vitrectomy shows reduction in macular thickness (202 µm) and a restoration of the foveal contour.

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