Skip to main content

Advertisement

Log in

Vitrectomy for Diabetic Macular Edema

  • Diabetic Retinopathy: Medical and Surgical Therapies (S. Kiss, Section Editor)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

Abstract

Diabetic macular edema (DME) can often be a difficult disease to manage with a subset of patients not improving with existing treatments. As indicated in early studies, patients with hyaloid-retinal traction may benefit the most from vitrectomy for DME. However, some patients without evidence of hyaloid traction may also improve after vitrectomy. It is difficult to predict which patients will improve with surgery. In addition, as treatment options have evolved, the appropriate timing of vitrectomy for DME remains controversial. An improvement in imaging modalities and enhanced understanding of the pathophysiology of the disease may aid in the appropriate use of this treatment option.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Klein R, Klein BEK, Moss SE, et al. The Wisconsin epidemiologic study of diabetic retinopathy XV: the long-term incidence of macular edema. Ophthalmology. 1995;102:7–16.

    Article  CAS  PubMed  Google Scholar 

  2. Bhagat N, Grigorian RA, Tutela A, et al. Diabetic macular edema: pathogenesis and treatment. Surv Ophthalmol. 2009;54:1–32.

    Article  PubMed  Google Scholar 

  3. Moss SE, Klein R, Klein BEK. The 14-year incidence of visual loss in a diabetic population. Ophthalmology. 1998;105:998–1003.

    Article  CAS  PubMed  Google Scholar 

  4. Ferris FL 3rd, Patz A. Macular edema: a complication of diabetic retinopathy. Surv Ophthalmol. 1984;28:452–61.

    Article  PubMed  Google Scholar 

  5. ETDRS Research Group. Early photocoagulation for diabetic retinopathy: ETDRS number 9. Ophthalmology. 1991;98:766–85.

    Article  Google Scholar 

  6. Lee CM, Olk RJ. Modified grid laser photocoagulation for diffuse diabetic macular edema: long-term visual results. Ophthalmology. 1991;98:1594–602.

    Article  CAS  PubMed  Google Scholar 

  7. Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2002;119:789–801.

    Article  Google Scholar 

  8. Massin P, Bandello F, Garweg JG, et al. Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE study): a 12-month, randomized, controlled, double-masked, multicenter phase II study. Diabetes Care. 2010;33:2399–405.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Lewis H, Abrams GW, Blumenkranz MS, et al. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction. Ophthalmology. 1992;99:753–9.

    Article  CAS  PubMed  Google Scholar 

  10. Harbour JW, Smiddy WE, Flynn HW Jr, et al. Vitrectomy for diabetic macular edema associated with a thickened and taut posterior hyaloid membrane. Am J Ophthalmol. 1996;121:405–13.

    Article  CAS  PubMed  Google Scholar 

  11. Pendergast SD, Hassan TS, Williams GA, et al. Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol. 2000;130:178–86.

    Article  CAS  PubMed  Google Scholar 

  12. •• Diabetic Retinopathy Clinical Research Network Writing Committee on behalf of the DRCR.net, Haller JA, Qin H, Apte RS, et al. Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology. 2010;117:1087–93. This was the largest prospective cohort study specifically evaluating vitrectomy in patients with diabetic macular edema and vitreomacular traction.  This study includes OCT as well as visual acuity outcomes in these patients.

  13. Seko Y, Seko Y, Fujikura H, et al. Induction of vascular endothelial growth factor after application of mechanical stress to retinal pigment epithelium of the rate in vitro. Ophthalmol Vis Sci. 1999;40:3287–91.

    CAS  Google Scholar 

  14. Nasrallah FP, Jalkh AE, Van Coppenolle F, et al. The role of the vitreous in diabetic macular edema. Ophthalmology. 1988;95:1335–9.

    Article  CAS  PubMed  Google Scholar 

  15. Tachi N, Ogino N. Vitrectomy for diffuse macular edema in cases of diabetic retinopathy. Am J Ophthalmol. 1996;122:258–60.

    Article  CAS  PubMed  Google Scholar 

  16. Heij ECL, Hendrikse F, Kessels AGH, Derhaag PJFM. Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefe’s Arch Clin Exp Ophthalmol. 2001;239:264–70.

    Article  Google Scholar 

  17. Ikeda T, Sato K, Katano T, et al. Vitrectomy for cystoid macular oedema with attached posterior hyaloid membrane in patients with diabetes. Br J Ophthalmol. 1999;83:12–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Yamamoto T, Hitani K, Tsukahara I, et al. Early postoperative retinal thickness changes and complications after vitrectomy for diabetic macular edema. Am J Ophthalmol. 2003;135:14–9.

    Article  PubMed  Google Scholar 

  19. Otani T, Kishi S. Tomographic assessment of vitreous surgery for diabetic macular edema. Am J Ophthalmol. 2000;129:487–94.

    Article  CAS  PubMed  Google Scholar 

  20. Otani T, Kishi S. A controlled study of vitrectomy for diabetic macular edema. Am J Ophthalmol. 2002;134:214–9.

    Article  PubMed  Google Scholar 

  21. • Bonnin S, Sandali O, Bonnel S, et al. Vitrectomy with internal limiting membrane peeling for tractional and nontractional diabetic macular edema; long-term results of a comparative study. Retina. 2014. doi:10.1097/IAE.0000000000000433This paper includes long-term anatomical and visual acuity results of patients with both tractional and nontractional diabetic macular edema treated with vitrectomy, after failing laser and corticosteroid therapy.

  22. Figueroa MS, Contreras I, Noval S. Surgical and anatomical outcomes of pars plana vitrectomy of diffuse nontractional diabetic macular edema. Retina. 2008;28:420–6.

    Article  PubMed  Google Scholar 

  23. Mochizuki Y, Hata Y, Enaida H, et al. Evaluating adjunctive surgical procedures during vitrectomy for diabetic macular edema. Retina. 2006;26:143–8.

    Article  PubMed  Google Scholar 

  24. Patel JI, Hykin PG, Schadt M, et al. Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina. 2006;26:5–13.

    Article  PubMed  Google Scholar 

  25. •• Stefánsson E. Physiology of vitreous surgery. Graefes Arch Clin Exp Ophthalmol. 2009;247:147–63. This paper provides an in-depth review of the physiologic changes that occur in the eye after vitrectomy as well as lensectomy.

  26. Sebag J, Buckingham B, Charles MA, et al. Biochemical abnormalities in vitreous of humans with proliferative diabetic retinopathy. Arch Ophthalmol. 1992;110:1472–6.

    Article  CAS  PubMed  Google Scholar 

  27. Kent D, Vinores SA, Campochiaro PA. Macular oedema: the role of soluble mediators. Br J Ophthalmol. 2000;84:542–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Funatsu H, Yamashita H, Ikeda T, et al. Relation of diabetic macular edema to cytokines and posterior vitreous detachment. Am J Ophthalmol. 2003;135:321–7.

    Article  CAS  PubMed  Google Scholar 

  29. Yamamoto T, Yamamoto S, Takeuchi S. Pars plana vitrectomy for diabetic macular edema with posterior vitreous detachment. J Eye. 2000;17:133–8.

    Google Scholar 

  30. Yamamoto T, Akabane N, Takeuchi S. Vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane. Am J Ophthalmol. 2001;132:369–77.

    Article  CAS  PubMed  Google Scholar 

  31. • Flaxel CJ, Edwards AR, Aiello LP, et al. Factors associated with visual acuity outcomes after vitrectomy for diabetic macular edema: diabetic retinopathy clinical research network. Retina. 2010;30:1488–95. This paper provides a large (241 patients) prospective review of the factors associated with better outcome following vitrectomy for diabetic macular edema.

  32. Gandorfer A, Messmer EM, Ulbig MW, et al. Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina. 2000;20:126–33.

    Article  CAS  PubMed  Google Scholar 

  33. Kuhn F, Kiss G, Mester V, et al. Vitrectomy with internal limiting membrane removal for clinically significant macular oedema. Graefes Arch Clin Exp Ophthalmol. 2004;242:402–8.

    Article  PubMed  Google Scholar 

  34. Stefaniotou M, Aspiotis M, Kalogeropoulos C, et al. Vitrectomy results for diffuse diabetic macular edema with and without inner limiting membrane removal. Eur J Ophthalmol. 2004;14:137–43.

    CAS  PubMed  Google Scholar 

  35. •• Adelman A, Parnes A, Michalewska Z, et al. Strategy for the management of diabetic macular edema: the european vitreo-retinal society macular edema study. BioMed Res Int. 2015;2015:870987. This was a large (2,603 patients), nonrandomized, multicenter clinical study evaluating the efficacy of different treatments for diabetic macular edema.  This provided an opportunity to compare vitrectomy with ILM peeling with all other treatment options.

  36. Hoerauf H, et al. Pars plana vitrectomy for diabetic macular edema. Internal limiting membrane delamination vs posterior hyaloid removal. A prospective randomized trial. Graefes Arch Clin Exp Ophthalmol. 2011;249:997–1008.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Hartley KL, Smiddy WE, Flynn HW, et al. Pars plana vitrectomy with internal limiting membrane peeling for diabetic macular edema. Retina. 2008;28:410–9.

    Article  PubMed  Google Scholar 

  38. Sakamoto A, Nishijima K, Kita M, et al. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2009;247:1325–30.

    Article  PubMed  Google Scholar 

  39. Chhablani JK, Kim JS, Cheng L, et al. External limiting membrane as a predictor of visual improvement in diabetic macular edema after pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2012;250:1415–20.

    Article  PubMed  Google Scholar 

  40. Otani T, Kishi S. Tomographic findings of foveal hard exudates in diabetic macular edema. Am J Ophthalmol. 2001;131:50–4.

    Article  CAS  PubMed  Google Scholar 

  41. Takagi H, Otani A, Kiryu J, et al. New surgical approach for removing massive subfoveal hard exudates in diabetic macular edema. Ophthalmology. 1999;106:249–57.

    Article  CAS  PubMed  Google Scholar 

  42. Yang CM. Surgical treatment for severe diabetic macular edema with massive hard exudates. Retina. 2000;20:121–5.

    Article  CAS  PubMed  Google Scholar 

  43. Kumagai K, Furukawa M, Ogino N, et al. Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema. Retina. 2009;29:464–72.

    Article  PubMed  Google Scholar 

  44. Beer PM, Bakri SJ, Singh RJ, et al. Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection. Ophthalmology. 2003;110:681–6.

    Article  PubMed  Google Scholar 

  45. Yanyali A, Horozoglu F, Celik E, Nohutcu AF. Long-term outcomes of pars plana vitrectomy with internal limiting membrane removal in diabetic macular edema. Retina. 2007;27:557–66.

    Article  PubMed  Google Scholar 

  46. Kakinoki M, Sawada O, Sawada T, et al. Effect of vitrectomy on aqueous VEGF concentration and pharmacokinetics of bevacizumab in macaque monkeys. Invest Ophthalmol Vis Sci. 2012;53:5877–80.

    Article  CAS  PubMed  Google Scholar 

  47. Ahn J, Kim H, Woo SJ, et al. Pharmacokinetics of intravitreally Injected bevacizumab in vitrectomized eyes. J Ocul Pharmacol Ther. 2013;29:612–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Arevalo JF, Sanchez JG, Wu L, et al. Primary intravitreal bevacizumab for diffuse diabetic macular edema: the pan-american collaborative retina study group at 24 months. Ophthalmology. 2009;116:1488–97.

    Article  PubMed  Google Scholar 

  49. •• Kim JH, Kang SW, et al. Vitrectomy combined with intravitreal triamcinolone acetonide injection and macular laser photocoagulation for nontractional diabetic macular edema. Korean J Ophthalmol. 2013;27:186–93. This paper specifically looked at outcomes in patients with nontractional diabetic macular edema who received vitrectomy, intravitreal steroids and macular laser who previously were unresponsive to three or more anti-VEGF injections.

  50. Van Effenterre G, Guyot-Argenton C, Guiberteau B, et al. Macular edema caused by contraction of the posterior hyaloid in diabetic retinopathy: surgical treatment of a series of 22 cases. J Fr Ophtalmol. 1993;16:602–10.

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Anne E. Fung for her contribution to this review.

Disclosure

Dr. Coady and Dr. Adelman both declare they have no conflicts of interest

Human and Animal Rights and Informed Consent

This article contains no studies with human or animal subjects performed by the author

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patrick A. Coady.

Additional information

This article is part of the Topical Collection on Diabetic Retinopathy: Medical and Surgical Therapies.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Coady, P.A., Adelman, R.A. Vitrectomy for Diabetic Macular Edema. Curr Ophthalmol Rep 3, 132–138 (2015). https://doi.org/10.1007/s40135-015-0071-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40135-015-0071-y

Keywords

Navigation