Original article
Vitrectomy for Persistent Diffuse Diabetic Macular Edema

https://doi.org/10.1016/j.ajo.2005.03.045Get rights and content

Purpose

To evaluate the potential benefit of vitrectomy in eyes with persistent diffuse macular edema.

Design

Prospective randomized comparative clinical trial.

Methods

Eyes with diffuse diabetic macular edema for 6 to 18 months, an attached posterior hyaloid, and grid laser photocoagulation performed at least 4 months before were included. Patients were randomized either to a vitrectomy group or to a control group. main outcome measures: Evaluations of Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, reading vision, and retinal thickness were carried out at baseline and 1, 3, and 6 months after enrollment.

Results

Fifty-six eyes (100%) were enrolled in this study. Twenty-five eyes (44.6%) were randomized into Gr I (vitrectomy group) and 31 eyes (55.4%) into Gr II (controls). Both groups were comparable in mean age (62.7 years and 63.9 years) and distribution of gender (one third male, two thirds female).

ETDRS visual acuity showed a statistical significance in favor of Gr I at all time points (P = .035 to .005 Fisher′s exact test). With Jaeger charts a significance for Gr I was found only at the 6-month examination (P = .01). With optical coherence tomography, the different behavior of retinal thickness changes in both groups during follow-up was statistically significant; P values were <.0001 for month 1, 3, and 6, preferring Gr I.

Conclusions

We provide evidence that vitrectomy with internal limiting membrane peeling is superior to observation alone in eyes with persistent diffuse diabetic macular edema for 6 to 18 months. Longer follow-up periods and larger series might be needed to confirm these results and gain additional information.

Section snippets

Methods

This was a prospective randomized comparative clinical trial. Patients were included when they fulfilled the following criteria: history of diffuse macular edema for a minimum of 6 and a maximum of 18 months; grid laser photocoagulation performed at least 4 months earlier; a documented attached posterior hyaloid either with B-scan ultrasound examination or the presence of a preretinal membrane shown with optical coherence tomography (OCT); and no or only mild cataract, less than NO3NC3C3P3

Results

Fifty-six patients fulfilled the study criteria. All patients completed the 6-month examination; there were no dropouts during follow-up, and no data were missing for statistical analysis. One patient experienced a stroke after the 3 months control but could perform the final evaluation. In both groups, antihypertensive therapy was not changed and HbA1c was kept under 8.0. The mean age was 61.4 years (range 28 to 74), 30.3% (17 of 56) were male, and 69.7% (39 of 56) were female.

Twenty-five eyes

Discussion

Macular edema associated with diabetic retinopathy is one of the main causes of visual acuity impairment in patients with diabetes. According to a population-based study, edema within 1 disk diameter of the center of the macula was found in 9% of the diabetic population, approximately 40% of whom had central macular involvement resulting in visual deterioration.1, 7, 8

The pathogenesis of diabetic macular edema is multifactorial, implicating duration of diabetes, insulin dependence, highly

Ulrike Stolba, MD, has worked at the Department of Ophthalmology, Rudolf Foundation Hospital Vienna, Austria; Department of Ophthalmology, University Eye Clinic, Vienna, Austria; Department of Ophthalmology, University Eye Clinic, Vienna, Austria. From 1986 to 1995, she studied at the Department for Vitreoretinal Diseases at the Department of Ophthalmology, University Eye Clinic, Vienna, Austria and at the Department of Ophthalmology, University of Vienna, Austria. Dr. Stolba has published 54

References (38)

  • N. Tachi et al.

    Vitrectomy for diffuse macular edema in cases of diabetic retinopathy

    Am J Ophthalmol

    (1996)
  • T. Otani et al.

    Tomographic assessment of vitreous surgery for diabetic macular edema

    Am J Ophthalmol

    (2000)
  • T. Otani et al.

    A controlled study of vitrectomy for diabetic macular edema

    Am J Ophthalmol

    (2002)
  • S.D. Pendergast et al.

    Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyloid

    Am J Ophthalmol

    (2000)
  • T. Yamamoto et al.

    Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema

    Am J Ophthalmol

    (2003)
  • T. Hikichi et al.

    Association between the short-term natural history of diabetic macular edema and the vitreomacular relationship in type II diabetes mellitus

    Ophthalmology

    (1997)
  • P.R. Aroca et al.

    Risk factors for diffuse and focal macular edema

    J Diabetes Complications

    (2004)
  • R.N. Frank et al.

    Temporal variation in diabetic macular edema measured by optical coherence tomography

    Ophthalmology

    (2004)
  • F.P. Nasrallah et al.

    The role of the vitreous in diabetic macular edema

    Ophthalmology

    (1988)

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    Ulrike Stolba, MD, has worked at the Department of Ophthalmology, Rudolf Foundation Hospital Vienna, Austria; Department of Ophthalmology, University Eye Clinic, Vienna, Austria; Department of Ophthalmology, University Eye Clinic, Vienna, Austria. From 1986 to 1995, she studied at the Department for Vitreoretinal Diseases at the Department of Ophthalmology, University Eye Clinic, Vienna, Austria and at the Department of Ophthalmology, University of Vienna, Austria. Dr. Stolba has published 54 articles in English, German and French, and has contributed 10 book chapters. Her main interests are microsurgery, especially vitreoretinal surgery, diagnosis and treatment of AMD and diabetic complications, research in vitreous substitutes, AMD, and diabetes.

    Susanne Binder, MD, has been the chairman of the Department of Ophthalmology, Rudolf Foundation Clinic, since 1995, and has also been chairman of the Ludwig Boltzmann Institute of Retinology and Biomicroscopic Laser Surgery since 1997, both in Vienna, Austria. In addition, Dr. Binder has worked at the University Eye Clinic B, Vienna General Hospital, University of Vienna Medical School, Vienna, Austria; Professor of Ophthalmology, University Eye Clinic, Vienna, Austria; Vitreoretinal Diseases, First University Eye Clinic, Vienna, Austria. She has published 142 articles in English and German, edited two books, published 30 surveys and book chapters, in addition to 24 miscellaneous articles. As an editor, Dr. Binder has served on the editorial board of Graefe’s Arch Clin Exp Ophthalmol;Ophthamologica; the editor-in-chief of Spektrum der Augenheilkunde, The Journal of the Austrian Ophthalmological Society. Primary interests include microsurgery, vitreoretinal surgery and -diseases, research in AMD, especially retinal transplantation, retinal vascular diseases. She is a member of AAO, ARVO, Retina Society, Association of Retinal Specialists, Club Jules Gonin, and other national and international societies.

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