Abstract
Background
Little has been published on internal limiting membrane (ILM) removal for clinically significant macular oedema (CSME) in eyes not improving following maximal laser treatment.
Methods
Retrospective review of the charts and intraoperative video films of 30 consecutive eyes of 27 patients undergoing vitrectomy, ILM peeling, and gas tamponade by a single surgeon.
Results
The average patient was 52 years old; 56% were males. The oedema was caused by diabetes in 87% of the eyes, 42% of which had proliferative disease. The oedema was diffuse in 16 eyes (53%) and cystoid (CME) in 14 (47%). In 21% of eyes, spontaneous vitreous detachment was present or the eye had already undergone vitrectomy. All but one eye had at least 6 months of follow-up (mean 12 months). The oedema resolved completely in 26 eyes (90%) and partially in 3 eyes (10%). The visual acuity improved at least two Snellen lines in 19 eyes (66%) and one line in 4 eyes (14%); the average improvement was 4 lines. The acuity was unchanged in three eyes (10%) and worsened in three eyes (10%), all due to cataract. Among the 14 eyes with CME, 11 (79%) became completely dry and the visual acuity improved in 11 eyes (79%). No ILM-related complication was encountered in any eye.
Conclusions
Vitrectomy with ILM peeling is a promising approach to eyes with CSME. It appears to offer visual improvement at a much higher rate than laser therapy and with a longer-lasting effect than that of intravitreal triamcinolone. A larger study is necessary to confirm these preliminary findings.
Similar content being viewed by others
References
Benz M, Murray T, Dubovy S, Katz R, Eifrig C (2003) Endophthalmitis caused by Mycobacterium chelonae abscessus after intravitreal injection of triamcinolone. Arch Ophthalmol 121:271–273
Blankenship G (1979) Diabetic macular edema and argon laser photocoagulation: a prospective randomized study. Ophthalmology 86:69–78
Ciardella A, Schiff W, Barile G, Vidne O, Sparow J, Langton K, Chang S (2003) Persistent indocyanine green fluorescence after vitrectomy for macular hole. Am J Ophthalmol 136:174–177
Early Treatment Diabetic Retinopathy Study Group (1985) Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report No. 1. Arch Ophthalmol 103:1796–1806
Engelbrecht N, Freeman J, Sternberg P J, Aaberg T S, Aaberg T J, Martin D, Sippy B (2002) Retinal pigment epithelial changes after macular hole surgery with indocyanine green-assisted internal limiting membrane peeling. Am J Ophthalmol 89–94
Gandorfer A, Messmer E, Ulbig M, Kampik A (2000) Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina 20:126–133
Garcia-Arumi J, Martinez V, Sararols L, Corcostegui B (2003) Vitreoretinal surgery for cystoid macular edema associated with retinitis pigmentosa. Ophthalmology 110:1164–1169
Greenstein V, Holopigian K, Hood D, Seiple W, Carr R (2000) The nature and extent of retinal dysfunction associated with diabetic macular edema. Invest Ophthalmol Vis Sci 41:3643–3654
Hammond C, Chauhan D, Stanford M (1998) Pulmonary hypertension and diffuse macular edema responsive to acetazolamide. Arch Ophthalmol 116:1535–1536
Harbour J, Smiddy W, Flynn H J, Rubsamen P (1996) Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol 121:405–413
Haritoglou C, Gandorfer A, Gass C, Schaumberger M, Ulbig M, Kampik A (2002) Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation. Am J Ophthalmol 836–841
Hykin P, Shields C, Shields J, Arevalo J (1998) The efficacy of focal laser therapy in radiation-induced macular edema. Ophthalmology 105:1425–1429
Ikeda T, Sato K, Katano T, Hayashi Y (2000) Improved visual acuity following pars plana vitrectomy for diabetic cystoid macular edema and detached posterior hyaloid. Retina 20:220–222
Jonas J, Kreissig I, Degenring R (2003) Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol 87:24–27
Jonas J, Kreissig I, Sofker A, Degenring R (2003) Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol 121:57–61
Klein R, Klein B, Moss S, Davis M, DeMets D (1984) The Wisconsin Epidemiologic Study of Diabetes. IV. Diabetic macular edema. Ophthalmology 91:1464–1474
Kuhn F (2002) To peel or not to peel, that is the question. Ophthalmology 109:9-11
Kuhn F (2003) Internal limiting membrane removal for macular detachment in highly myopic eyes. Am J Ophthalmol 135:547–549
Kumagai K, Ogino N, Furukawa M, Demizu S, Atsumi K, Kurihara H (2002) Internal limiting membrane peeling in vitreous surgery for diabetic macular edema. Acta Soc Ophthalmol Jpn 106:590–594
Kwok A, Lai T, Yew D, Li W (2003) Internal limiting membrane staining with various concentrations of indocyanine green dye under air in macular surgeries. Am J Ophthalmol 223–230
La Heij E, Hendrikse F, Kessels A, Derhaag P (2001) Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefes Arch Clin Exp Ophthalmol 239:264–270
Lee C, Olk R (1991) Modified grid laser photocoagulation for diffuse diabetic macular edema: long-term visual results. Ophthalmology 98:1594–1602
Lee C, Olk R, Akduman L (2000) Combined modified grid and panretinal photocoagulation for diffuse diabetic macular edema and proliferative diabetic retinopathy. Ophthalmic Surg Lasers 31:292–300
Lewis H, Abrams G, Blumenkranz M, Campo R (1992) Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology 99:753–759
Martidis A, Duker J, Greenberg P, Rogers A, Puliafito C, Reichel E, Baumal C (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109:920–927
Massin P, Duguid G, Erginay A, Haouchine B, Gaudric A (2003) Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy. Am J Ophthalmol 135:169–177
Melberg N, Thomas M (1995) Visual field loss after pars plana vitrectomy with air/fluid exchange. Am J Ophthalmol 120:386–388
Otani T, Kishi S (2002) A controlled study of vitrectomy for diabetic macular edema. Am J Ophthalmol 134:214–219
Park D, Schatz H, McDonald H, Johnson R (1997) Grid laser photocoagulation for macular edema in bilateral juxtafoveal telangiectasis. Ophthalmology 104:1838–1846
Patz A, Shatz H, Gittlesohn A, Berkow J, Ticho U (1973) Macular edema—an overlooked complication of diabetic retinopathy. Trans Pa Acad Ophthalmol Otolaryngol 77:34–41
Pendergast S, Hassan T, Williams G, Cox M, Margherio R, Ferrone P, Garretson B, Trese M (1999) Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol 130:178–186
Pendergast S, McCuen BI (1996) Visual field loss after macular hole surgery. Ophthalmology 103:1069–1077
Pendergast S, Margherio R, Williams G, Cox MJ (1999) Vitrectomy for chronic pseudophakic cystoid macular edema. Am J Ophthalmol 128:317–323
Peyman G, Canakis C, Livir-Rallatos C, Conway M (2002) The effect of internal limiting membrane peeling on chronic recalcitrant pseudophakic cystoid macular edema: a report of two cases. Am J Ophthalmol 133:571–572
Rojas B, Zafirakis P, Christen W, Markomichelakis N, Foster C (1999) Medical treatment of macular edema in patients with uveitis. Doc Ophthalmol 97:399–407
Rossetti L, Bujtar E, Castoldi D, Torrazza C, Orzalesi N (1996) Effectiveness of diclofenac eyedrops in reducing inflammation and the incidence of cystoid macular edema after cataract surgery. J Cataract Refract Surg 22 [Suppl 1]:794–799
Saika S, Tanaka T, Miyamoto T, Ohnishi Y (2001) Surgical posterior vitreous detachment combined with gas/air tamponade for treating macular edema associated with branch retinal vein occlusion: retinal tomography and visual outcome. Graefes Arch Clin Exp Ophthalmol 239:729–732
Sato Y, Lee Z, Shimada H (2002) Vitrectomy for diabetic cystoid macular edema. Jap J Ophthalmol 46:315–322
Tachi N, Ogino N (1996) Vitrectomy for diffuse macular edema in cases of diabetic retinopathy. Am J Ophthalmol 122:258–260
Takahashi M, Hikichi T, Akiba J, Yoshida A, Trempe C (1997) Role of the vitreous and macular edema in branch retinal vein occlusion. Ophthalmic Surg Lasers 28:294–299
Tehrani N, Saeed T, Murray P (2000) Deep intramuscular methylprednisolone for the treatment of cystoid macular oedema in uveitis. Eye 14:691–694
Thach A, Dugel P, Flindall R, Sipperley J, Sneed S (1997) A comparison of retrobulbar versus sub-Tenon’s corticosteroid therapy for cystoid macular edema refractory to topical medications. Ophthalmology 104:2003–2008
Uemura A, Kanda S, Sakamoto Y, Kita H (2003) Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling. Am J Ophthalmol 252–257
Welch J (1997) Dehydration injury as a possible cause of visual defect after pars plana vitrectomy for macular hole. Am J Ophthalmol 124:698–699
Yamaguchi Y, Otani T, Kishi S (2003) Resolution of diabetic cystoid macular edema associated with spontaneous vitreofoveal separation. Am J Ophthalmol 135:116–118
Yamamoto T, Akabane N, Takeuchi S (2001) Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol 132:369–377
Yamamoto T, Hitani K, Tsukahara I, Yamamoto S, Kawasaki R, Yamashita H, Takeuchi S (2003) Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema. Am J Ophthalmol 135:14–19
Acknowledgement
The authors wish to thank Gerald McGwin, Jr., MS, PhD, at the Department of Ophthalmology, University of Alabama at Birmingham, for the statistical analysis.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuhn, F., Kiss, G., Mester, V. et al. Vitrectomy with internal limiting membrane removal for clinically significant macular oedema. Graefe's Arch Clin Exp Ophthalmol 242, 402–408 (2004). https://doi.org/10.1007/s00417-004-0876-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-004-0876-0