Vitrectomy for diabetic macular edema and the relevance of external limiting membrane

Purpose To evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. Methods Medical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent). Results Ninety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 +/- 0.28 and 0.52 +/- 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 +/- 209.1 mu m preoperatively and 327 +/- 66.1 mu m postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 +/- 0.14 vs. 0.7 +/- 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 +/- 54.6 mu m; ELM disruption: 334 +/- 75.2, p = 0.31). Conclusions PPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact.

Automated summary

The study evaluated the relevance of external limiting membrane (ELM) in eyes with diabetic macular edema (DME) post pars plana vitrectomy (PPV). Eyes with intact ELM preoperatively had significantly better final visual outcomes. Early PPV treatment is recommended for DME patients with intact ELM to maximize benefits.