1.
[Comparison of pars plana vitrectomy with ILM peeling and intravitreal triamcinolone in diffuse diabetic macular oedema].
Khurieva-Sattler, E, Krause, M, Löw, U, Gatzioufas, Z, Toropygin, S, Seitz, B, Ruprecht, K, Hille, K
Klinische Monatsblatter fur Augenheilkunde. 2010;(6):496-500
Abstract
BACKGROUND Visual outcome and anatomic results in patients with diffuse diabetic macular oedema (DDME) were evaluated after vitrectomy with internal limiting membrane (ILM) peeling versus intravitreal triamcinolone acetonide (TA). MATERIALS AND METHODS A prospective, non-randomised pilot study included 41 eyes (35 patients) with clinically significant DDME. In 24 eyes (group A) we performed pars plana vitrectomy with ILM peeling. Seventeen eyes (group B) received an injection of 10 mg TA. Best corrected visual acuity and central macular thickness (measured with OCT) were determined preoperatively as well as 1 and 4 months postoperatively. RESULTS In group A, OCT showed a macular thickness of 403 +/- 142 microm preoperatively. Best corrected visual acuity was 0.24 +/- 0.18. One month after surgery, macular thickness decreased to 311 +/- 62 microm (p = 0.06 ns) and visual acuity was 0.17 +/- 0.14 (ns). Four months after surgery, macular thickness remained significantly lower compared with preoperative values, at 307 +/- 161 microm (p = 0.012). There was a tendency towards a higher visual acuity of 0.30 +/- 0.26 (p = 0.32 ns). Before TA injection, macular thickness in group B was 551 +/- 180 microm and visual acuity was 0.19 +/- 0.14. One month after TA, macular thickness decreased to 242 +/- 82 (p = 0.001) microm while visual acuity increased to 0.31 +/- 0.21 (p = 0.005). At 4 months follow-up, group B showed recurrence of macular oedema. Compared with the preoperative findings macular thickness was significantly lower (368 +/- 159 microm; p = 0,001). Best corrected visual acuity after 4 months was 0.27 +/- 0.17 and did not differ significantly from the preoperative visual acuity (p = 0.033 ns). CONCLUSIONS Intravitreal TA as a single treatment reduces the extent of DDME within a short time after surgery. These promising results may not be stable during long-term follow-up, necessitating in many cases a re-injection of TA. Macular oedema reduction after vitrectomy with ILM peeling, however, remains stable for more than 4 months and, therefore, offers more permanent results. However, none of these treatments facilitated a significant visual acuity restoration 4 months postoperatively.
2.
[Is removal of internal limiting membrane always necessary during surgery for refractory diffuse diabetic macular edema without evident epimacular proliferation?].
Aboutable, T
Klinische Monatsblatter fur Augenheilkunde. 2006;(8):681-6
Abstract
PURPOSE The aim of this study was to evaluate the effect of the internal limiting membrane (ILM) peeling in eyes with diabetic macular edema (DME) but without evident epimacular proliferation or cellophane maculopathy that were unresponsive to laser photocoagulation. Secondly we wanted to determine whether ILM peeling is always essential in DME surgery and whether it improves the functional outcome. PATIENTS AND METHODS In a prospective controlled study, ten patients with similar degrees and duration of DME in both eyes were followed-up for more than 6 months after bilateral vitrectomy with and without ILM peeling. Trypan blue 0.2 % was used to stain the ILM during surgery. We evaluated the anatomic outcome as detected by bimicroscopic evaluation and optical coherence tomography (OCT) and the visual outcome. Intraoperatively and postoperatively any complications occurring were documented. RESULTS Baseline BCVA and foveal thickness ranged, respectively, from 20/50 to 20/400 (mean 20/110) and 430 to 840 microm (mean 618) in eyes that underwent ILM peeling, 20/40 to 20/400 (mean 20/120) and 390 to 910 microm (mean 623 microm) in eyes without ILM peeling. There were no significant differences between the both groups in baseline BCVA (P = 0.4691, Wilcoxon rank sum test) or foveal thickness (P = 0.8204, Wilcoxon rank sum test). At six-months follow-up, mean BCVA improved significantly in both groups, from 20/110 to 20/60 (P = 0.0427, Wilcoxon signed rank test) in eyes that underwent ILM peeling and from 20/120 to 20/80 (P = 0.0482, Wilcoxon signed rank test) in eyes without ILM peeling. Mean foveal thickness decreased significantly from 618 to 265 (P = 0.0050) in eyes with ILM peeling and from 623 to 311 (P = 0.0050) in eyes without ILM peeling. Visual acuity improved by two or more lines in five eyes (50 %) of each group. There were no significant differences in the improvement of BCVA and decreasing of foveal thickness between the both groups (Wilcoxon rank sum test, P = 0.9083, P = 0.2720, respectively). Cyst rupture with formation of macular hole was documented in one eye after ILM peeling. CONCLUSIONS Vitrectomy with or without ILM peeling may improve BCVA and decrease foveal thickness. ILM peeling was not found to enhance the improvement of VA postoperatively. A larger study is required to determine whether ILM peeling is essential in surgery for DME without epimacular proliferation or cellophane maculopathy.