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Title

PARS PLANA VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING FOR REFRACTORY DIFFUSE DIABETIC MACULAR EDEMA

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 Start Page 162 | End Page 167

Abstract

 Purpose: To evaluate the effect of PARS PLANA VITRECTOMY (PPV) with INTERNAL LIMITING MEMBRANE (ILM) peeling for management of refractory diffuse diabetic MACULAR EDEMA (DME).Methods: In this prospective interventional case series, eyes with refractory diffuse DME unresponsive to macular photocoagulation and/or intravitreal bevacizumab, and best corrected visual acuity (BCVA)³20/200 and£20/60 underwent triamcinoloneassisted PPV with ILM peeling. Pre- and postoperative evaluations included a complete ophthalmologic examination, fluorescein angiography and optical coherence tomography (OCT). Main outcome measures were BCVA and CENTRAL MACULAR THICKNESS (CMT).Results: Twelve eyes of 12 patients with mean age of 59.6±3.9 (range, 55-68) years were operated and followed for a mean period of 4.9±1.0 (range, 4-6) months. Mean BCVA at final examination was 0.82±0.18 log MAR which was not significantly better than its preoperative value of 1.00±0.80 logMAR (P=0.959). Visual acuity improved by at least 2 lines in 3 eyes (25%), remained stable in 7 eyes (58%) and decreased by at least 2 lines in 2 eyes (17%). Mean CMT at final examination was 315±95 mm, which was significantly less than its preoperative value of 467±107 mm (P=0.004). Complications included vitreous hemorrhage in 2 and cataract progression in 5 eyes.Conclusion: PPV with ILM peeling for refractory diffuse DME seems to reduce macular thickness, but does not significantly improve visual acuity as observed after an intermediate-term follow up of about 6 months.

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