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Vitreous and intraretinal macular changes in diabetic macular edema with and without tractional components

Authors
  • Romano, Mario R.
  • Allegrini, Davide
  • Della Guardia, Chiara
  • Schiemer, Stefano
  • Baronissi, Immacolata
  • Ferrara, Mariantonia
  • Cennamo, Gilda
Type
Published Article
Journal
Graefe's Archive for Clinical and Experimental Ophthalmology
Publisher
Springer Berlin Heidelberg
Publication Date
Oct 31, 2018
Volume
257
Issue
1
Pages
1–8
Identifiers
DOI: 10.1007/s00417-018-4173-8
Source
Springer Nature
Keywords
License
Yellow

Abstract

Diabetic macular edema (DME) is still one of the main causes of visual impairment. Repeated intravitreal injections of ranibizumab are considered the gold standard treatment, but the efficacy in patients with prominent cystic characteristics remains uncertain. In diabetic retinas, the identification of both antero-posterior and, particularly, tangential tractions is crucial to prevent misdiagnosis of tractional and refractory DME, and therefore to prevent poor treatment outcomes. The treatment of tractional DME with anti-VEGF injections could be poorly effective due to the influence of a tractional force. Pars plana vitrectomy (PPV) is a surgical procedure that has been widely used in the treatment of diffuse and refractory DME. Anatomical improvement, although stable and immediate, did not result in visual improvement. PPV with internal limiting membrane (ILM) peeling for the treatment of non-tractional DME in patients with prominent cysts (> 390 μm) causes subfoveal atrophy, defined as “floor effect”. Epiretinal tangential forces and intraretinal change evaluation by SD-OCT of non-tractional DME are essential for determining appropriate management.

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