Diabetic Macular Edema: One Surgery or 30 Injections ?


Diabetes is a disease whose incidence is increasing throughout the entire world. The most common cause of blindness of all the ocular complications of diabetes is macular edema. Today we have numerous treatment options to offer to the patient: corticosteroid and antiVEGF injections into the vitreous cavity as well as certain implants. While most of these medications are effective, they are so with one caveat: they need to be repeated on a regular basis. For those who treat the sick tissue, and the patient with the sick tissue, this is not a problem: they will inject the drug into the eye every time the vision drops or the OCT shows a thickening of the central retina. This involves a logistical nightmare for the institution, a tremendous cost for the entire health care system, and, most importantly, it causes an emotional rollercoaster for the patient. Surgery is now out of fashion because no “level one evidence” study has shown that it works – because no such study has been conducted, nor will one ever be organized, due to a lack of financial support. Those very few studies that did examine the role of surgery were nonstandardized and were done either late or as a last resort, when all else has already failed. This explains why the published results with surgery are not that impressive. The first author has operated on thousands of eyes in over 25 years with (diabetic) macular edema. With over 80% of eyes achieving permanent disappearance of the fluid and low complication rate, the only real question regarding the indication remains this: How soon, or at what visual acuity level, should vitrectomy (with ILM peeling and typically endolaser, be performed? The results show that answer is: early; the patient should be offered surgery as a first line of treatment. The most ideal option is the operate on a “dry eye”, in which a preoperative intravitreal injection has dried the macula.



Ferenc Kuhn
Saint Johns, United States
Email : fkuhn@mindspring.com
Cell Phone: +19044636428
Work Phone: +19044636428