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Diabetic ME

Left Right

870 cases of diabetic edema superior to 300 microns have been sent by 60 retina specialists.The initial VA were much higher in eyes treated by Grid lasers, while eyes treated by vitrectomy and ILM peeling had avery worse initial VA.

The treatment distribution is more equally divided.

When considering all the treatments without exclusion, the improvement obtained for these DME is lower than the average one.

Triamcinolone, as well as both grid lasers do not provide very exciting curves. We can note that sub-threshold grid laser has the same effect as threshold grid laser.Anti-VEGF gives a rising curve which exceed 2 LogMAR lines.ILM peeling seems to result in very favorable results starting from 3 lines at three months to finish at more than 8 lines at 24 months.

If we consider the other treatment options.

We can see that adding threshold grid laser to anti-VEGF decreases the anti-VEGF effect.

Same results if we add sub-threshold grid laser to anti-VEGF.

Adding Triamcinolone to threshold grid laser does not seem to help very much.

Adding Triamcinolone decreases the anti-VEGF as well.

Same conclusion for adding Triamcinolone to ILM peeling.

The number of cases improving 3 lines or more is much higher after ILM peeling than after AntiVEGF and this is statistically significant. Same thing for cases improving 6 lines or more. However, this classical way of presentation is not very meaningful since the improvement is dependent on the pre-treatment VA.

Much more accurate could be this way of presentation where the improvements can be compared taking into consideration the initial VA.According to that, we can award the gold medal to PPV + ILM with a medium improvement 2 to 3 times higher than the one obtained by the combination of ILM peeling and triamcinolone which can receive the silver medal and three times higher than antiVEGF alone which receives the bronze medal.

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