Efficiency of Vitrectomy in Diabetic Macular Edema and Morphometry of Surgically Removed of the Internal Limiting Membrane


Authors: J. Kalvoda 1;  J. Dušková 2;  Z. Kovařík 1;  A. Kuběna 3;  B. Kalvodová 1
Authors‘ workplace: Oční klinika, 1. lékařská fakulta, Univerzita Karlova v Praze a Všeobecná fakultní nemocnice, Praha, přednostka doc. MUDr. Bohdana Kalvodová, CSc., 2Ústav patologie, 1. lékařská fakulta, Univerzita Karlova v Praze a Všeobecná fakultní nemocnice, Praha, př 1
Published in: Čes. a slov. Oftal., 66, 2010, No. 2, p. 76-82

Overview

Aim:
To evaluate the efficiency of vitrectomy with peeling of the internal limiting membrane (ILM) in eyes with diffuse and/or cystoid nontractional diabetic macular edema (ME) refractory to macular laser photocoagulation. Histopathologic and morphometric analysis of the ILM in diabetic eyes was performed. Thickness of the ILM was correlated with the level of glykosylated hemoglobin (HbA1C) and other clinical factors.

Material and methods:
The prospective study involved 56 eyes of 52 diabetic patients with a mean age of 63 ± 7.6 years. Vitrectomy with trypan blue-assisted ILM peeling was performed in standard way. Mean follow-up period was 8.7 months (range 3 – 19 months). The ILM was fixed immediately after peeling in 2.5 % glutaraldehyde and submitted for electron microscopic evaluation. The ILM was photographed in standard magnification (x 5000) with the scale of 1 μm in the shot.

Results:
Statistical analysis of the postoperative visual acuity (VA) in the study group of 56 eyes proved a general improvement with prevalence of the resulted VA in intervals 0.1–0.2 and 0.5–1.0 related to ETDRS chart. The VA was improved by at least 2 lines in 29 eyes of 56 eyes (51.8%), one line in 6 eyes (10.7%) and remained unchanged in 11 eyes (19.6%). The postoperative VA deteriorated by one line in 2 eyes (3.6%) and at least 2 lines in 8 eyes (14.3%). Morphometric analysis demonstrated a significant thickening of the ILM in all eyes with a mean thickness of the ILM 3.61 ± 1.22 μ m. It was found that a higher thickness of the ILM is related to elevated HbA1C by both types of diabetes mellitus (DM) (p = 0.040). We also found significant dependence of ILM thickness in relation to duration of DM by comparison of men and women (p = 0.026) and significant correlation between ILM thickness and the age of diabetic patients related to their gender (p = 0.029).

Conclusions:
Vitrectomy with peeling of the ILM in eyes with chronic diffuse and/or cystoid nontractional diabetic ME mildly improves the VA and extends a hope for its stabilization. We confirmed increased thickness of the surgically peeled ILM and statistically significant correlations to elevated HbA1C by both types of DM and to further clinical characteristics of case series. Morphometric and histopathologic analyses of the ILM contribute to more objective evaluation of ultrastructure of the vitreomacular interface.

Key words:
diabetic macular edema, internal limiting membrane, morphometry, vitrectomy, glykosylated hemoglobin


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