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Multicenter Study
. 2025 Sep;263(9):2651-2662.
doi: 10.1007/s00417-025-06845-2. Epub 2025 May 6.

Efficacy of vitrectomy combined with and without cataract surgery for diabetic macular edema: one-year follow-up multi-center study in Japan

Yutaka Yamada  1 , Yoshihiro Takamura  2 , Kazuma Saito  3 , Akira Minamoto  4 , Gaku Ishigooka  5 , Takashi Koto  6 , Yuki Nakano  7 , Eiko Tsuiki  8 , Hiroto Terasaki  9 , Miho Shimizu  10 , Masayo Kimura  11 , Yoshinori Mitamura  12 , Reio Sekine  13 , Yutaro Mizusawa  14 , Takao Hirano  15 , Tomoyuki Oyama  16 , Takeshi Iwase  17 , Fumiaki Higashijima  18 , Hisashi Matsubara  19 , Masaru Inatani  1 ; J.-CREST (Japan Clinical REtina STudy group)
Collaborators, Affiliations
Multicenter Study

Efficacy of vitrectomy combined with and without cataract surgery for diabetic macular edema: one-year follow-up multi-center study in Japan

Yutaka Yamada et al. Graefes Arch Clin Exp Ophthalmol. 2025 Sep.

Abstract

Purpose: To evaluate the efficacy of vitrectomy, with and without cataract surgery, for diabetic macular edema (DME) in Japan.

Method: This retrospective study was conducted at 22 sites in Japan and enrolled patients who underwent vitrectomy either without (VIT group) or with (VIT + CS group) cataract surgery. Central retinal thickness (CRT) and best-corrected visual acuity (BCVA) were measured before surgery and at 1, 3, 6, and 12 months after surgery.

Results: A total of 722 patients with DME (482 in the VIT + CS group and 240 in the VIT group) were enrolled. CRT significantly decreased after 1 month and continued thereafter in both groups. BCVA significantly improved at 1 month in the VIT + CS group and at 6 months in the VIT group. In both groups, regardless of epiretinal membrane removal, CRT and BCVA significantly improved, with no additional benefit from concomitant internal limiting membrane peeling. The change in BCVA was significantly correlated with the change in CRT during 6 months postoperatively in all patients and in the VIT group. Patients with worse preoperative visual acuity had a higher likelihood of improved BCVA at 6 and 12 months after surgery. No significant difference in BCVA was observed before and after surgery in patients with a preoperative visual acuity of 20/40 or better. However, in patients with a visual acuity of 20/50 or worse, BCVA significantly improved 1 month after surgery.

Conclusion: Vitrectomy is anatomically and functionally effective for DME, and combined cataract surgery is beneficial in DME cases with cataracts. Patients with poor preoperative BCVA improved, while those with good vision maintained it. However, better preoperative vision increased the risk of postoperative deterioration, underscoring the need for careful evaluation of surgical indications.

Key messages: What is known In vitrectomy for diabetic macular edema (DME), DRCR.net showed that 13-31% of patients experience decreased vision despite reduced edema, leaving the efficacy of vitrectomy uncertain. What is new Our multicenter study demonstrated that vitrectomy with and without cataract surgery was effective in improving central retinal thickness and visual acuity in the patients with DME. Better preoperative visual acuity increased the risk of postoperative decline, and thus the need for careful evaluation of surgical indications.

Keywords: Cataract surgery; Diabetic macular edema; Epiretinal membrane; Vitrectomy.

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Conflict of interest statement

Declarations. Ethical approval: Our protocol was approved by the Institutional Review Board (IRB) of the University of Fukui, No 20230129. Informed consent: This study used an opt-out approach. Participants were provided with information about the study, including its objectives and the use of their data and were given the opportunity to decline participation. Human and animal rights: All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interests; expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
a Distribution of different grades of diabetic retinopathy, b the pattern of lasers in past history, and (c) gauge size employed during vitrectomy across all eyes, as well as in the eyes that underwent both vitrectomy and cataract surgery (VIT + CS group) and those that underwent only vitrectomy (VIT group)
Fig. 2
Fig. 2
A Change in central retinal thickness (CRT) postoperatively for all eyes (a), as well as for the VIT group and the VIT + CS group (b). (B) Change in best corrected visual acuity (BCVA) postoperatively for all eyes (c) and for eyes that underwent only vitrectomy (VIT group) versus those that underwent vitrectomy with cataract surgery (VIT + CS group) (d). *p < 0.05 (CRT or BCVA compared with baseline). #p < 0.05 (VIT group vs. VIT + CS group)
Fig. 3
Fig. 3
A Distribution of the cases involving the removal of epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. The black, light gray, dark gray, and white bars represent the presence of ERM peeling, absence of ERM peeling, presence of ILM peeling, and absence of ILM peeling, respectively. B Temporal profiles of CRT and BCVA in relation to the presence or absence of ERM peeling and ILM peeling. *p < 0.05 (CRT or BCVA compared with baseline)
Fig. 4
Fig. 4
A Linear correlation between the change of central CRT and BCVA from baseline to 6 months after surgery. The solid line represents the regression line. B Comparison of preoperative BCVA between groups with worsening BCVA postoperatively and those with improving BCVA. *p < 0.05
Fig. 5
Fig. 5
A Distribution of the change in visual outcome based on different preoperative BCVA. The black, white, and light gray bars represent worse, unchanged, and better changes of BCVA. B Temporal profiles of BCVA and CRT according to different preoperative BCVA. *p < 0.05 (CRT or BCVA compared with baseline)
Fig. 6
Fig. 6
Representative cases show the change of OCT images between before and at 6 months after vitrectomy (Case 1: 49-year-old male, case 2: 65-year-old female, case 3: 59-year-old female, case 4: 67-year-old male). The BCVA improved postoperatively in case 1 and 3, worse in case 2, and unchanged in case 4. The values shown in upper left corner in each image are best corrected visual acuity
Fig. 7
Fig. 7
A The number of cases that received intravitreal injections of anti-VEGF agents before and after surgery for 1 year. B Linear correlation between the change of BCVA for 12 months after surgery and the number of injections of anti-VEGF agents for 1 year preoperatively and postoperatively. The solid line represents the regression line
See this image and copyright information in PMC

References

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