Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction

Abstract

Purpose: To evaluate vitrectomy for diabetic macular edema (DME) in eyes with at least moderate vision loss and vitreomacular traction.

Design: Prospective cohort study.

Participants: The primary cohort included 87 eyes with DME and vitreomacular traction based on investigator's evaluation, visual acuity 20/63-20/400, optical coherence tomography (OCT) central subfield >300 microns and no concomitant cataract extraction at the time of vitrectomy.

Methods: Surgery was performed according to the investigator's usual routine. Follow-up visits were performed after 3 months, 6 months (primary end point), and 1 year.

Main outcome measures: Visual acuity, OCT retinal thickening, and operative complications.

Results: At baseline, median visual acuity in the 87 eyes was 20/100 and median OCT thickness was 491 microns. During vitrectomy, additional procedures included epiretinal membrane peeling in 61%, internal limiting membrane peeling in 54%, panretinal photocoagulation in 40%, and injection of corticosteroids at the close of the procedure in 64%. At 6 months, median OCT central subfield thickness decreased by 160 microns, with 43% having central subfield thickness <250 microns and 68% having at least a 50% reduction in thickening. Visual acuity improved by > or =10 letters in 38% (95% confidence interval, 28%-49%) and deteriorated by > or =10 letters in 22% (95% confidence interval, 13%-31%). Postoperative complications through 6 months included vitreous hemorrhage (5 eyes), elevated intraocular pressure requiring treatment (7 eyes), retinal detachment (3 eyes), and endophthalmitis (1 eye). Few changes in results were noted between 6 months and 1 year.

Conclusions: After vitrectomy performed for DME and vitreomacular traction, retinal thickening was reduced in most eyes. Between 28% and 49% of eyes with characteristics similar to those included in this study are likely to have improvement of visual acuity, whereas between 13% and 31% are likely to have worsening. The operative complication rate is low and similar to what has been reported for this procedure. These data provide estimates of surgical outcomes and serve as a reference for future studies that might consider vitrectomy for DME in eyes with at least moderate vision loss and vitreomacular traction.

Conflict of interest statement

Conflicts of interest statement: A complete list of all DRCR.net investigator financial disclosures can be found at www.drcr.net.

Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Distribution of Change in Visual Acuity from Baseline

Figure 2

Distribution of Change in optical coherence tomography (OCT) Central Subfield Thickness in Categories According to Baseline Thickness Box-whisker plot demonstrating mean (dashed horizontal line), median (solid horizontal line), 25 – 75th percentiles (extremes of the box), 10–90th percentiles (whiskers) and 5–95th percentiles (solid circles) of change in optical coherence tomography (OCT) central subfield.

Figure 3

Comparison of Change in Optical Coherence Tomography (OCT) Central Subfield and Change in Visual Acuity from Baseline to 6 Months. The solid line represents the regression line and the dotted lines represent the 95% confidence interval for the mean.