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Is immediate treatment necessary for diabetic macular edema after pars plana vitrectomy for tractional complications of proliferative diabetic retinopathy?

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Abstract

Purpose

To assess the treatment benefit of eyes with diabetic macular edema (DME) in vitrectomized eyes for tractional complications of proliferative diabetic retinopathy (PDR).

Methods

In a retrospective multicentre observational study in India, the clinical outcomes of eyes with center-involving DME in vitrectomized eyes for tractional complications of PDR in people with type 2 diabetes with at least 12 months follow-up data were assessed. The DME status and visual acuity outcomes were compared between those who received treatment versus those observed.

Results

In the 10-year study period, 45 eyes of 44 patients from 5 tertiary centers in India met the inclusion criteria. Center-involving DME was documented after a mean of 7 ± 7 months following pars plan vitrectomy (PPV) for tractional complications of PDR. More than half of the (n = 25) eyes were immediately treated for DME, and treatment was deferred for the rest. At one year, there was a statistically significant reduction in mean central subfield thickness in treated (467.9 ± 124.8 μm to 367.8 ± 143.7 μm; p < 0.001) as well as observed (405.2 ± 132.6 μm to 325.6 ± 149 μm; p < 0.001) eyes, and the change was comparable (p = 0.574). The change in vision was also comparable (0.12 ± 0.31 and 0.22 ± 0.54 Log MAR in the treated and observed group, respectively; p = 0.443).

Conclusion

Treatment for pre-existing or new-onset DME after PPV for tractional complications of PDR may be deferred for up to one year because the DME may resolve spontaneously with time.

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Acknowledgements

This study was done within the ORNATE India project funded by the GCRF UKRI (MR/P207881/1). The research is supported by the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology.

Funding

Hyderabad Eye Research Foundation, Hyderabad, India (UCB, TD, PKR, BP); and Research Council UK.

Author information

Authors and Affiliations

  1. Retina Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, India

    Umesh Chandra Behera, Tushar Agarwal & Suman Sahu

  2. Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India

    Taraprasad Das & Padmaja Kumari Rani

  3. NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, EC1V 2PD, UK

    Sobha Sivaprasad

  4. Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India

    Rajiv Raman & Harshit Vaidya

  5. Vitreoretinal Services, Dr. Shroff’s Charity Eye Hospital, New Delhi, India

    Manisha Agarwal

  6. Retina Vitreous Service, L V Prasad Eye Institute, Vishakhapatnam, India

    Bhavik Panchal

Authors
  1. Umesh Chandra Behera
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  2. Taraprasad Das
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  3. Sobha Sivaprasad
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  4. Padmaja Kumari Rani
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  5. Rajiv Raman
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  7. Tushar Agarwal
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  8. Suman Sahu
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  9. Harshit Vaidya
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  10. Bhavik Panchal
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Consortia

On behalf of the India Retinal Disease Study group

Corresponding author

Correspondence to Umesh Chandra Behera.

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Conflicts of interest

The authors have no financial or non-financial interests to disclose.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Ethics Committee (IRB) of L V Prasad Eye Institute Bhubaneswar approved this study (IEC code 2019–143-IM-28).

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing data and photographs.

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Behera, U.C., Das, T., Sivaprasad, S. et al. Is immediate treatment necessary for diabetic macular edema after pars plana vitrectomy for tractional complications of proliferative diabetic retinopathy?. Int Ophthalmol 41, 3607–3614 (2021). https://doi.org/10.1007/s10792-021-01923-w

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  • DOI: https://doi.org/10.1007/s10792-021-01923-w

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