Ivan Fiser, Martina Rubesova (Prague, Czech Republic)

Advantages:

We consider diabetic macular edema a very individual disease, which cannot be treated according to a single template. No doubt that in focal edema the direct laser coagulation of leaking MA brings the best effect. Diffuse edema is more questionable; grid laser is controversial or even harmful, steroids have a limited benefit and negative side effects, and Avastin has a short effect. ILM peeling really works well in most cases, its effect is long lasting but in some patients it is not satisfactory. In these cases, we try to look for additional procedures, like additional laser, or Avastin, or rarely TMC. We also try to base the treatment on the patient´ s wishes, needs and fears. Diabetic maculopathy is a disease where the physician has to use his instinct and sensibility, and show his art besides his handcraft.

Methods:

A group of 50 eyes with DME was treated using above-mentioned methods. Ten eyes with focal DME were very successfully treated using focal laser. Forty eyes underwent ILM peeling with success, there were only three recurrences of DME, but some issues arose, see below.

Effectiveness / Safety:

We have statistical evidence proving that the ILM peeling is a very effective method to treat diffuse DME. We can also prove that focal laser is very efficient in focal DME.

However, we will also show controversial cases in which postoperatively appeared:

a) a weak effect,
b) a recurrence of DME after initial success,
c) an atrophy of RNFL and optic disc, or
d) an iris rubeosis and NVG.

We will also show a rare case of CNV developing after treatment of DME using Avastin and laser.

Take home message:

DME needs to be treated individually, according to specific conditions of the retina and according to the best experience and art of the surgeon. It is perhaps advisable to assess the extent of retinal ischemia using FA before vitrectomy and eventually treat the retina with laser peroperatively.