Back to Journals » Clinical Ophthalmology » Volume 10

Vitrectomy for center-involved diabetic macular edema

Authors Browning D, Lee C, Stewart M, Landers M

Received 23 January 2016

Accepted for publication 8 March 2016

Published 26 April 2016 Volume 2016:10 Pages 735—742

DOI https://doi.org/10.2147/OPTH.S104906

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Gokcen Gökçe

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


David J Browning,1 Chong Lee,1 Michael W Stewart,2 Maurice B Landers III3

1Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, NC, 2Mayo Clinic, Jacksonville, FL, 3Kittner Eye Center, University of North Carolina, Chapel Hill, NC, USA

Purpose: To determine the effect of vitrectomy for center-involved diabetic macular edema (CI-DME).
Methods: This was a retrospective study of 53 eyes of 45 patients who had vitrectomy for CI-DME and were followed up for at least 12 months. Charts were reviewed for visual acuity (VA), central subfield mean thickness measured by optical coherence tomography, presurgical and postsurgical interventions for CI-DME, and number of office visits in the first 12 months after surgery. Preoperative spectral domain optical coherence tomography was performed on 38 patients, and they were graded for ellipsoid zone (EZ) intactness by three independent graders with assessment of agreement between graders using intraclass correlation coefficients and Bland–Altman analysis.
Results: The median VA improved from 20/100 (interquartile range [IQR], 20/63–20/200) at baseline to 20/63 (IQR, 20/32–20/125) at 12 months. The median central subfield mean thickness improved from 505 µm (IQR, 389–597 µm) at baseline to 279 µm (IQR, 246–339 µm) at 12 months. Intergrader agreement for EZ intactness was moderate (intraclass correlation coefficients 0.4294–0.6356). There was no relationship between preoperative intactness of the EZ and the 12-month change in VA.
Conclusion: Vitrectomy consistently thins the macula in CI-DME and, on average, leads to clinically significant improvement in VA comparable in size to that reported with serial intravitreal anti-vascular endothelial growth factor injections. A large, comparative, prospective, randomized clinical trial of these two treatments is needed to determine which is more effective and cost-effective.

Keywords:
center-involved diabetic macular edema, diabetic macular edema, vitrectomy, spectral domain OCT

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]