Advantages:

PPV is a useful method in management of non-tractional, non-ischemic resistant diffuse diabetic macular edema associated with type 1 DM

Methods:

Type 1 Diabetic macular edema (DME) is typically managed by thermal laser, intravitreal injections and systemic control. An entity of diffuse DME persists despite all therapies. We present 5 cases of diffuse non-tractional, non-ischemic diffuse DME in type 1 DM managed by clear vitrectomy with non-peeling of ILM and removal of posterior hyaloid. Mean retinal thickness was 459 microns. Post-operatively, there was a mean improvement in macular thickness over 1, 3, 6 and 12 months follow up to 278 microns. Visual acuity improved in 3 cases and were stable in 2 cases.

Effectiveness / Safety:

Clear vitrectomy is a useful adjunct in managing diffuse resistant, non-tractional DME in type 1 DM.

Take home message:

PPV may be considered in management of resistant diffuse macular edema. Presumed mechanisms include altering vitreous milieu and increased oxygenation.