Vitrectomy in the management of diabetic macular edema in treatment-naïve patients

Abstract

Objective: To determine the efficacy of vitrectomy in eyes with treatment-naïve diabetic macular edema (DME).

Methods: Consecutive patients with treatment-naïve DME who underwent pars plana vitrectomy with internal limiting membrane peeling at a single institution were identified from the electronic medical records. Morphologic and visual acuity changes from baseline were analyzed at both the primary temporal endpoint (6 months) and the final examination with the investigators. The primary outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT).

Results: Forty-four eyes of 44 patients were included in this retrospective study. The mean BCVA improved significantly from baseline until the 6-month primary endpoint (1.35 logMAR vs 0.83 logMAR, p < 0.001) and stabilized through the final examination (0.77 logMAR). The BCVA improved by at least 0.1, 0.3, and 0.6 logMAR in 26 (60%), 24 (55%), and 14 (32%) of eyes, respectively, whereas it worsened by 0.3 logMAR in only 1 (2%) eye. Final BCVA correlated inversely with duration of diabetes (p = 0.01), presence of an epiretinal membrane (p = 0.02), and initial visual acuity (p = 0.03). Mean CRT decreased significantly from baseline through 6 months (595 µm vs 266 µm; p < 0.001), and edema recurred in only 3 eyes (6%), one of which was subsequently treated with intravitreal bevacizumab.

Conclusions: Pars plana vitrectomy significantly improves macular edema and visual acuity in eyes with treatment-naïve DME. Prospective randomized trials are needed to better determine the efficacy of early vitrectomy.