Pars Plana Vitrectomy for Tractional Diabetic Macular Edema with or without Internal Limiting Membrane Peeling

Abstract

Abstract Background: To assess the efficacy of pars plana vitrectomy (PPV) in management of tractional diabetic macular edema (DME) and highlight the benefits of additional internal limiting membrane (ILM) peeling. Methods: This an open-label, prospective, comparative and interventional study that enrolled 50 eyes with tractional DME that underwent PPV were split into two groups: group (A) consisted of 25 eyes that did not have ILM peeling, and group (B) consisted of 25 eyes that did. One, three, and six months after surgery, a postoperative assessment was completed. Results: Mean best corrected visual acuity (BCVA) in group (A) has improved from (0.89 the logarithm of minimal angle of resolution [LogMAR]) preoperatively to (0.64 LogMAR, p <0.001), and mean central macular thickness (CMT) declined from (471.28μm) to (228.20μm, p <0.001) after six months of PPV. In group (B), mean BCVA has improved from (0.83 LogMAR) preoperatively to (0.58 LogMAR, p <0.001), and mean CMT decreased from (496.84μm) to (226.20μm, p <0.001) after six months of PPV. There were no significant differences between the two groups after 1, 3, and 6 months according to the delta change % of BCVA and CMT. A significant negative correlation was detected between preoperative glycosylated hemoglobin (HbA1c) and BCVA improvement. Conclusions: PPV surgery is an effective treatment of tractional DME. Additional ILM peeling is not accompanied by extra benefits in a short period. Long-term glycemic control plays a role in vision gain after vitrectomy in diabetic patients.