Transconjunctival 25-gauge pars plana vitrectomy and internal limiting membrane peeling for chronic macular edema

Minhee Cho, Donald J D'Amico, Minhee Cho, Donald J D'Amico

Abstract

Background: The purpose of this study was to investigate the visual and anatomic outcomes in patients with chronic macular edema who underwent 25-gauge pars plana vitrectomy with internal limiting membrane peeling.

Methods: This study was a retrospective chart review of 24 eyes from 21 patients who underwent 25-gauge pars plana vitrectomy and indocyanine green-assisted internal limiting membrane peeling for chronic macular edema. Preoperative and postoperative spectral-domain optical coherence tomography (OCT) was examined for macular thickness and macular volume. Outcomes and variables were analyzed using the two-tailed t-test and Spearman's rank correlation coefficient.

Results: Twenty-four eyes from 11 men and 10 women of mean age 69 (range 55-84) years were included. Four patients (17%) had chronic macular edema from uveitis, four (17%) from retinal vein occlusion, and 16 (67%) from diabetes. Mean visual acuity was 20/103 preoperatively and 20/87 postoperatively (P = 0.55). Sixty-three percent of the eyes had improved vision (47% better than 20/40), 21% maintained the same vision, and 17% had worse vision. Forty-seven percent of improved eyes and 30% of total eyes gained more than two lines of visual acuity (range -9 to +7 lines). Mean macular thickness was 455 μm preoperatively and 396 μm postoperatively (P = 0.29). Mean macular volume was 7.9 mm(3) preoperatively and 7.5 mm(3) postoperatively (P = 0.51). The strongest predictor of postoperative visual acuity was initial visual acuity (r = 0.673, P = 0.0003).

Conclusion: Even though a majority of patients had improved vision and decreased macular thickening after 25-gauge pars plana vitrectomy with internal limiting membrane peeling for chronic macular edema of various etiologies, the difference in visual acuity or macular thickening did not reach statistical significance.

Keywords: 25-gauge vitrectomy; chronic macular edema; diabetes mellitus; internal limiting membrane peeling; uveitis; vein occlusion.

Figures

Figure 1
Figure 1
(A) A 55-year-old man with chronic macular edema from proliferative diabetic retinopathy, status post focal laser treatment (case 11 in Table 1). Preoperative vision was 20/200. The preoperative spectral-domain OCT shows cystic edema mostly in the outer nuclear layer. The macular thickness measured 527 μm. (B) Postoperative OCT 5 months later shows resolution of cystic macular edema. Visual acuity is 20/100, and macular thickness is decreased to 262 μm. (C) A 67-year-old woman with chronic macular edema from nonproliferative diabetic retinopathy, status post focal laser, intravitreal bevacizumab and triamcinolone injections (case 14 in Table 1). Preoperative vision was 20/100. The preoperative spectral-domain OCT shows an attached posterior hyaloid, a large cystoid space, and cystic edema, mostly in the outer plexiform layer. The inner/outer segment junction is intact. Macular thickness measured 543 μm. (D) Postoperative spectral-domain OCT 5 months later shows worsening of the central cystoid space. Central foveal thickness increased to 605 μm, but vision improved to 20/80. (E) A 68-year-old man with chronic macular edema from nonproliferative diabetic retinopathy without previous treatment (case 10 in Table 1). Preoperative vision was 20/200. The preoperative spectral-domain OCT shows an attached posterior hyaloid and cystic edema in the inner and outer plexiform layers as well as evidence of trace subretinal fluid. Central foveal thickness measured 655 μm. (F) Postoperative spectral-domain OCT 8 months later shows resolution of macular edema (central foveal thickness 385 μm), but subretinal fibrosis is evident. The inner/outer segment junction is attenuated subfoveally. Visual acuity is decreased to counting finger vision. Abbreviation: OCT, optical coherence tomography.

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