TEM of epiretinal tissue in diabetic macular oedema


SYNEK Svatopluk PÁČ Libor SYNKOVÁ Monika

Year of publication 2006
Type Article in Periodical
Magazine / Source Acta Ophthalmologica scandinavica
MU Faculty or unit

Faculty of Medicine

Field ORL, ophthalmology, stomatology
Keywords TEM; diabetic macular oedema
Description Purpose Diabetic cystoid macular oedema (DME) is common cause of visual acuity decrease. Good anatomical results and visual acuity(VA) of pars plana vitrectomy(PPV) in a case of macular hole with internal limiting membrane peeling leeds to usage of this technique in DME. Favourable results even in a case without vitreoretinal traction leeds to conclusion that pathogenesis of this disease is different. Methods 21eyes from 19 patients with DME that had undergone PPV and peeling ILM were analyzed retrospectively. Half of them were laser treated before surgery. All eyes had an attached posterior hyaloids membrane in the macular region, but without thickening and without traction.Parts of excised tissues were examined by transmissive electron microscopy(TEM). Results Median duration of DME at the time of PPV was approximately 11.0 months. The median preoperative best-corrected VA of 0.08, improved to a median postoperative VA of 0.25. 7 eyes without preoperative laser coagulation had a median VA improvement of 77%, while 12 eyes with preoperative macular laser treatment had a median VA improvement of 14.8%. In all 21 eyes, DME was no longer visible on microscopic examination after a median period of 3.0 months after PPV. TEM samples contained ILM, glial cells and connective tissue and can be classified in monolayer membrane, multilayer membrane and true epimacular fibrous membrane. Conclusions PPV and peeling ILM resulted in the resolution of oedema, with an improvement in visual acuity in the majority of cases. Eyes without preoperative macular photocoagulation had a significantly higher visual improvement than eyes with preoperative laser treatment. A randomized controlled prospective trial of PPV versus laser is needed to determine the role of PPV as treatment modality for DME
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