Some years ago, the option of PPV as a therapeutic approach to DME was popular, but it is now outdated: intravitreal injections are the standard of care. But being outdated, doesn’t mean being useless. There is no doubt that the aim of whatever therapy we decide to try for VASCULAR edema must target the neuroinflammation that is the cause of it, but this is not the point.
The Qs are two:
Can vitrectomy be used as an anti-inflammatory therapy? And:
Are there forms of DME where neuro-inflammation is not the only and the main component on the field? Diabetic Vitreopathy consists in an anomalous cross linking of collagen fibers that modifies the structure of the peripheral vitreous, the so called vitreous cortex, that becomes thicker, more rigid and more waterproof than in normal subjects Moreover, high levels of inflammatory citochines are present in the diabetic vitreous, and this presence stimulates migration of inflammatory cells from the retina to the vitreous, obviously especially in the vitreal cortex. As a result, there is a further increased vitreoretinal adherence, a further reduced permeability, condensation and contraction of posterior hjaloid. Vitrectomy may therefore result useful in case of DME for many reasons: to remove a concomitant traction, to contribute to retina wash out of inflammatory cytochines and cells, to remove stiff and less permeable vitreal cortex and also ILM.


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