Vitrectomy with Internal Limiting Membrane Peeling for Management of Diabetic Macular Edema with Plaque Like Sub-foveal Exudates


SCIENTIFIC POSTER

Vitrectomy with Internal Limiting Membrane Peeling for Management of Diabetic Macular Edema with Plaque Like Sub-foveal Exudates by Sangeet Mittal, India


ABSTRACT

Purpose:

Exudative diabetic maculopathy is a common cause of severe and irreversible visual loss in patients with diabetic retinopathy. Plaque like sub-foveal hard exudates usually respond poorly to focal laser treatment. Vitrectomy helps to remove tractional forces at retinal surface, reduce the oxygen consumption of vitreous and decrease the VEGF load. Surgical excision of hard exudates is technically demanding and complicated. We analyze the efficacy of vitrectomy with Internal Limiting Membrane ( ILM) peeling alone in the treatment of plaque like sub-foveal hard exudates.

Methods:

Retrospective review of records of 556 eyes which had undergone vitrectomy for complications of Diabetic Retinopathy from 1/1/2013 to 31/12/2015 was done. 17 eyes of 16 patients with plaque like sub-foveal hard exudates that underwent standard 3 port pars plana vitrectomy (25 Gauge) combined with ILM peeling using Indo-cyanine Green dye were analyzed. All patients were under strict metabolic control for at least 6 weeks before the surgery. Only patients who had completed 6 months of follow up were included in the study. Main outcome measures evaluated included visual acuity, size of plaque like exudates and surgical complications.

Results:

Mean age of patients was 51.6±8.7 years. There were 13 males and 4 females. Mean follow up was 15.5 months. The mean visual acuity improved from 20/250 to 20/90. Improvement in visual acuity was seen in 15 out of 17 eyes. 6 patients had total resorption of hard exudates and 11 patients had partial absorption. One patient had retinal detachment during surgery for which silicon oil was injected. However complete resorption of hard exudative plaque was seen in this patient also.

Conclusions:

Vitrectomy with ILM peeling is a simple and effective option in the management of exudative diabetic maculopathy with plaque like sub-foveal hard exudates. Prospective randomized controlled trials are necessary to substantiate the above findings.


CONTACT DETAILS

 

Sangeet Mittal
Jalandhar, India
Email : sangeetmittal@rediffmail.com
Cell Phone: +919988998844
Work Phone: +911812272607