A Comparative Study Between Vitrectomy with & without ILM Peeling for Tractional Diabetic Macular Edema as Regards Anatomical and Electrophysiological Changes of the Macula

Abstract

ith increasing prevalence of diabetes mellitus and increasing life span of persons with diabetes, diabetic retinopathy (DR) is set to be the leading global cause of vision loss in many countries The exact pathogenesis of Diabetic macular edema (DME) is still unclear. Recent evidence indicates that diabetic retinopathy (DR) is a neurovascular disease of the retina. Retinal neuronal abnormalities are present well before the retinal microvascular injury. Increased vaso-permeability occurs as a result of breakdown of the blood retinal barrier (BRB) due to many factors: altered glial cells, loss of pericytes, endothelial cell death, leukostasis in the retinal vasculature, poor function of the tight junctions in the retinal vasculature, upregulation & expression of vascular endothelial growth factor (VEGF) and protein kinase C (PKC), and altered vitreo-retinal interface with a thickened taut posterior hyaloid with persistent vitreo-macular traction [VMT]. Patients with tractional DME has blurring of vision, loss of contrast sensitivity and color vision, metamorphopsia that can be demonstrated on Amsler grid. Spectral domain high definition OCT (SD-OCT) allows non-invasive visualization and imaging of vitreomacular interface and is an important tool in the diagnosis and