Early potoperative retinal thickne change and complication after vitrectomy for diabetic macular edema

Purpoe To determine the early potoperative change in retinal thickne and complication after par plana vitrectomy for diabetic macular edema. Deign Conecutive interventional cae erie. Method tudied retropectively, par plana vitrectomy wa performed on 65 conecutive eye of 63 patient with diabetic macular edema. The follow-up interval ranged from 6 to 36 month (12.6 ± 7.4 month [mean ± tandard deviation (D)]). The indication of par plana vitrectomy in thi tudy were (1) diffue diabetic macular edema, (2) preoperative viual acuity le than 20/40, and (3) noneffective macular photocoagulation therapy. Preoperative and potoperative examination by tereocopic biomicrocopy, color fundu photography of the macula and optical coherence tomography (OCT) were performed on all eye. Preoperatively, direct photocoagulation to microaneurym in the macula had been performed in 48 eye, and focal/grid photocoagulation had been performed in five eye. Preoperative examination howed that epiretinal membrane were oberved in 20 eye, cytoid macular edema in 40 eye, and 23 eye had a complete poterior vitreou detachment (PVD). Epimacular membrane, removed during urgery, were examined hitopathologically. Reult The potoperative mean bet-corrected viual acuity (logarithm of the minimum angle of reolution [logMAR] = 0.696 ± 0.491 [mean ± D]) wa ignificantly better than the preoperative mean bet-corrected viual acuity (0.827 ± 0.361; P < .0001; Wilcoxon igned-rank tet). The final viual acuity improved by 2 or more line in 32 of 65 eye (45%), remained unchanged in 32 of 65 eye (49%), and exacerbated after the urgery in 4 of 65 eye (6%) due to neovacular glaucoma (2 eye) and reidual cytoid macular edema (2 eye). The potoperative foveal retinal thickne (224.9 ± 116.9 μm) at the lat viit wa ignificantly thinner than the preoperative foveal retinal thickne (463.7 ± 177.3 μm; P < .0001; Wilcoxon igned-rank tet). The foveal retinal thickne did not decreae linealy but fluctuated: The mean potoperative retinal thickne had decreaed ignificantly 7 day after urgery, then remained unchanged for approximately 1 month, and thereafter gradually decreaed until 4 month. The intraoperative and potoperative complication included peripheral retinal tear in 3 of 65 (4.6%) eye, potoperative rhegmatogenou retinal detachment in 1 of 65 (1.5%) eye, neovacular glaucoma in 3 of 65 (5%) eye, recurrent vitreou hemorrage in 1 of 65 (1.5%) eye, hard exudate in the center of the macula in 3 of 56 (4.6%) eye, potoperative epiretinal membrane formation in 9 of 65 (13.8%) eye, and a lamellar macular hole in 1 of 65 (1.5%) eye. Concluion Vitrectomy for diabetic macular edema i an effective procedure for reducing the edema and improving viual acuity. Becaue the potoperative reduction in retinal thickne i not complete until 4 month, the aement of vitrectomy on foveal thickne hould not be made until thi time. In addition, there are evere complication from vitrectomy for diabetic macular edema, and careful preoperative and potoperative examination and urgical method are required