Role of pars plana vitrectomy with internal limiting membrane peel in patients of refractory diabetic macular edema

Yasir Afzal, Asad Aslam Khan, Nasir Chaudhary, Irfan Qayyum


Objective: To see the role of pars plana vitrectomy (PPV) with Internal Limiting Membrane (ILM) peel in patients of refractory diabetic macular edema in reducing central macular thickness.

Introduction: Diabetic macular edema (DME) is a major cause of visual morbidity in diabetic patients. Vitrectomy for DME has seemingly gained rapid, widespread acceptance but studies evaluating the efficacy of vitrectomy (with or without ILM peeling) have yielded conflicting results. The role of Internal Limiting Membrane (ILM) peeling in the treatment of DME is also controversial, and sufficient data to clarify its role have not yet been available.

Study Design: Quasi experimental study.

Place & Duration of Study: Vitreo retina clinic, Department of Ophthalmology, Mayo Hospital Lahore.

Methodology: Pre-operatively, Central Macular Thickness (CMT) was measured with Optical Coherent Tomogram (OCT). OCT was performed with a standard protocol of 6mm radial scan centered at patient’s fovea. All patients underwent 23G Pars plana Vitrectomy (PPV) by single surgeon. After completing vitrectomy and fluid-air exchange, ILM was stained with brilliant blue G for 4 to 5 minutes. ILM peeling was done in all twenty cases with iatrogenic macular hole formation in two cases and retinal bleeding in vitreous cavity in three cases. Patients were followed up till 3 months postoperative. Post-operatively central macular thickness was measured by OCT after one month and three months respectively.

Results:. Preoperative mean CMT of patients was 439.35±103.82. At 1st month post-operative it was 266.00±81.51 and at 3rd month post-operative it was 254.00±85.32. The decrease in CMT post operatively at 3rd month is statistically significant.

Conclusion: Pars plana vitrectomy with ILM peel has significant role in reducing refractory diabetic macular edema.

Key words: Refractory Diabetic macular edema, Central macular thickness, Pars plana vitrectomy, Internal limiting membrane peel

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