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Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema

Background: Currently, the gold standard of diabetic macular edema (DME) treatment is anti-vascular endothelial growth factor (VEGF) injections, although a percentage of patients do not respond optimally. Vitrectomy with or without internal limiting membrane (ILM) peeling is a well-established treat...

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Autores principales: Ranno, Stefano, Vujosevic, Stela, Mambretti, Manuela, Metrangolo, Cristian, Alkabes, Micol, Rabbiolo, Giovanni, Govetto, Andrea, Carini, Elisa, Nucci, Paolo, Radice, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10056256/
https://www.ncbi.nlm.nih.gov/pubmed/36983298
http://dx.doi.org/10.3390/jcm12062297
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author Ranno, Stefano
Vujosevic, Stela
Mambretti, Manuela
Metrangolo, Cristian
Alkabes, Micol
Rabbiolo, Giovanni
Govetto, Andrea
Carini, Elisa
Nucci, Paolo
Radice, Paolo
author_facet Ranno, Stefano
Vujosevic, Stela
Mambretti, Manuela
Metrangolo, Cristian
Alkabes, Micol
Rabbiolo, Giovanni
Govetto, Andrea
Carini, Elisa
Nucci, Paolo
Radice, Paolo
author_sort Ranno, Stefano
collection PubMed
description Background: Currently, the gold standard of diabetic macular edema (DME) treatment is anti-vascular endothelial growth factor (VEGF) injections, although a percentage of patients do not respond optimally. Vitrectomy with or without internal limiting membrane (ILM) peeling is a well-established treatment for DME cases with a tractional component while its role for nontractional cases is unclear. The aim of this study is to evaluate the role of vitrectomy with or without ILM peeling in nontractional refractory DME. Methods: We performed a retrospective review of twenty-eight eyes with nontractional refractory DME treated with vitrectomy at San Giuseppe Hospital, Milan, between 2016 and 2018. All surgeries were performed by a single experienced vitreoretinal surgeon. In 43.4% of cases, the ILM was peeled. Best corrected visual acuity and optical coherence tomography (OCT) scans were assessed preoperatively and at 6, 12, and 24 months post-vitrectomy. Results: The mean central macular thickness improved from 413.1 ± 84.4 to 291.3 ± 57.6 μm at two years (p < 0.0001). The mean logarithm of the minimum angle of resolution logMAR best-corrected visual acuity (BCVA) improved after two years, from 0.6 ± 0.2 to 0.2 ± 0.1 (p < 0.0001). We found no difference between ILM peeling vs. no ILM peeling group in terms of anatomical (p = 0.8) and visual outcome (p = 0.3). Eyes with DME and subfoveal serous retinal detachment (SRD) at baseline had better visual outcomes at the final visit (p = 0.001). Conclusions: We demonstrated anatomical and visual improvement of patients who underwent vitrectomy for nontractional refractory DME with and without ILM peeling. Improvement was greater in patients presenting subretinal fluid preoperatively.
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spelling pubmed-100562562023-03-30 Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema Ranno, Stefano Vujosevic, Stela Mambretti, Manuela Metrangolo, Cristian Alkabes, Micol Rabbiolo, Giovanni Govetto, Andrea Carini, Elisa Nucci, Paolo Radice, Paolo J Clin Med Brief Report Background: Currently, the gold standard of diabetic macular edema (DME) treatment is anti-vascular endothelial growth factor (VEGF) injections, although a percentage of patients do not respond optimally. Vitrectomy with or without internal limiting membrane (ILM) peeling is a well-established treatment for DME cases with a tractional component while its role for nontractional cases is unclear. The aim of this study is to evaluate the role of vitrectomy with or without ILM peeling in nontractional refractory DME. Methods: We performed a retrospective review of twenty-eight eyes with nontractional refractory DME treated with vitrectomy at San Giuseppe Hospital, Milan, between 2016 and 2018. All surgeries were performed by a single experienced vitreoretinal surgeon. In 43.4% of cases, the ILM was peeled. Best corrected visual acuity and optical coherence tomography (OCT) scans were assessed preoperatively and at 6, 12, and 24 months post-vitrectomy. Results: The mean central macular thickness improved from 413.1 ± 84.4 to 291.3 ± 57.6 μm at two years (p < 0.0001). The mean logarithm of the minimum angle of resolution logMAR best-corrected visual acuity (BCVA) improved after two years, from 0.6 ± 0.2 to 0.2 ± 0.1 (p < 0.0001). We found no difference between ILM peeling vs. no ILM peeling group in terms of anatomical (p = 0.8) and visual outcome (p = 0.3). Eyes with DME and subfoveal serous retinal detachment (SRD) at baseline had better visual outcomes at the final visit (p = 0.001). Conclusions: We demonstrated anatomical and visual improvement of patients who underwent vitrectomy for nontractional refractory DME with and without ILM peeling. Improvement was greater in patients presenting subretinal fluid preoperatively. MDPI 2023-03-15 /pmc/articles/PMC10056256/ /pubmed/36983298 http://dx.doi.org/10.3390/jcm12062297 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Ranno, Stefano
Vujosevic, Stela
Mambretti, Manuela
Metrangolo, Cristian
Alkabes, Micol
Rabbiolo, Giovanni
Govetto, Andrea
Carini, Elisa
Nucci, Paolo
Radice, Paolo
Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema
title Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema
title_full Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema
title_fullStr Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema
title_full_unstemmed Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema
title_short Role of Vitrectomy in Nontractional Refractory Diabetic Macular Edema
title_sort role of vitrectomy in nontractional refractory diabetic macular edema
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10056256/
https://www.ncbi.nlm.nih.gov/pubmed/36983298
http://dx.doi.org/10.3390/jcm12062297
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