Hassan Mortada (Cairo, Egypt)

Advantages:

PPV, with or without ILM peeling relieves traction at the vitreoretinal interface, improves trans-vitreal oxygenation of the retina and removes growth factor reservoir in the premacular hyaloid.

Methods:

46 eyes with tractional diffuse diabetic macular edema underwent PPV: 12 eyes with taut adherent posterior hyaloid, 15 eyes with anterior-posterior traction, 13 eyes with proliferative epimacular membrane and 6 eyes with combination of traction. Vitrectomy was combined with phaco + PCIOL in 42 eyes. All eyes underwent peeling of adherent posterior hyaloid with or without peeling of epimacular membranes, shaving of basal vitreous gel and endolaser. ILM peeling was performed in 32/46 eyes. All eyes had pre & postoperative OCT, color fundus photography and fluorescein angiography.

Effectiveness / Safety:

PPV, with or without ILM peeling resulted in decrease or resolution of tractional diffuse diabetic macular edema with improvement of visual acuity in 40/46 eyes (87%). Persistent or recurrent diffuse macular edema occurred in 6/46 eyes (13%). No operative or postoperative retinal complications were encountered.

Take home message:

PPV with or without ILM peeling is effective in resolving diffuse diabetic macular edema associated with traction at the vitreoretinal interface in 87%. Resolution of macular edema is associated with improvement of visual acuity, except in eyes with macular ischemia. Persistent or recurrent diffuse macular edema, due to unknown reason, was encountered in 13%.