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document
Pars plana vitrectomy for diabetic macular edema . Internal limiting membrane delamination vs posterior hyaloid removal . A prospective randomized trial . BACKGROUND Diabetes mellitus , as well as subsequent ocular complications such as cystoid macular edema ( CME ) , are of fundametal socio-economic relevance . Therefore , we evaluated the influence of internal limiting membrane ( ILM ) removal on longterm morphological and functional outcome in patients with diabetes mellitus ( DM ) type 2 and chronic CME without evident vitreomacular traction . METHOD Forty eyes with attached posterior hyaloid were included in this prospective trial and randomized intraoperatively . Prior focal ( n = 31 ) or panretinal ( n = 25 ) laser coagulation was permitted . Group I ( n = 19 patients ) underwent surgical induction of posterior vitreous detachment ( PVD ) , group II ( n = 20 patients ) PVD and removal of the ILM . Eleven patients with detached posterior hyaloid ( group III ) were not randomized , and ILM removal was performed . One eye had to be excluded from further analysis . Examinations included ETDRS best-corrected visual acuity ( BCVA ) , fluorescein angiography ( FLA ) and OCT at baseline , 3 and 6 months postoperatively . Main outcome measure was BCVA at 6 months , secondary was foveal thickness . RESULTS Mean BCVA over 6 months remained unchanged in 85 % of patients of group II , and decreased in 53 % of patients of group I . Results were not statistically significant different [ group I : mean decrease log MAR 95 % CI ( 0.06 ; 0.32 ) , group II : ( -0.02 ; 0.11 ) ] . OCT revealed a significantly greater reduction of foveal thickness following PVD with ILM removal [ group I : mean change : 95 % CI ( -208.95 μm ; -78.05 μm ) , group II : ( -80.90 μm : +59.17 μm ) ] . CONCLUSION Vitrectomy , PVD with or without ILM removal does not improve vision in patients with DM type 2 and cystoid diabetic macular edema without evident vitreoretinal traction . ILM delamination shows improved morphological results , and appears to be beneficial in eyes with preexisting PVD .
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Intervention_Surgical
Pars plana vitrectomy
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Intervention_Surgical
Internal limiting membrane delamination
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Intervention_Surgical
posterior hyaloid removal
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Intervention_Surgical
internal limiting membrane ( ILM ) removal
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Outcome_Physical
ETDRS best-corrected visual acuity ( BCVA )
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Outcome_Physical
6 months
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Outcome_Physical
thickness
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Participant_Condition
diabetes mellitus
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Participant_Condition
chronic CME
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Participant_Sample-size
Forty