Anatomical and Functional Change of the Macula after Vitrectomy of Tractional Diabetic Macular Edema

Abstract

SUMMARY AND CONCLUSION W 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 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. Patients with tractional DME has blurring of vision, loss of contrast sensitivity and color vision, metamorphopsia that can be demonstrated on Amsler grid. Optical Coherence Tomography (OCT) allows non-invasive visualization and imaging of vitreomacular interface and is an important tool in the diagnosis and management of VMT syndrome. Pars plana vitrectomy (PPV) with or without ILM peeling is the best line of treatment for symptomatic VMT, to release VMA in order to restore normal central retinal architecture. The vision is significantly improved in both ILM & non-ILM peeled groups, but non-ILM peeled group had better visual gain and final BCVA than ILM peeled group. CFT reduction occurred significantly in both groups after PPV. But the final CFT was much less in ILM peeled group. Complete resolution of macular edema was seen in ILM peeled group. PPV with or without ILM peeling don’t cause or impair any disruption of retinal photoreceptors, RPE, and ELM.