Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Refractory Diffuse Diabetic Macular Edema

Purpose: to evaluate the effect of pars plana vitrectomy (ppv) with internal limitingmembrane (ilm) peeling for management of refractory diffuse diabetic macularedema (dme).methods: in this prospective interventional case series, eyes with refractory diffusedme unresponsive to macular photocoagulation and/or intravitreal bevacizumab, andbest corrected visual acuity (bcva) ≥ 20/200 and ≤20/60 underwent triamcinoloneassistedppv with ilm peeling. pre- and postoperative evaluations included a completeophthalmologic examination, fluorescein angiography and optical coherence tomography(oct). main outcome measures were bcva and central macular thickness (cmt).results: twelve eyes of 12 patients with mean age of 59.±3.9 (range, 55-68) yearswere operated and followed for a mean period of 4.9±1.0 (range, 4-6) months. meanbcva at final examination was 0.82 ± 0.18 logmar which was not significantly betterthan its preoperative value of 1.00 ± 0.80 logmar (p=0.959). visual acuity improvedby at least 2 lines in 3 eyes (25%), remained stable in 7 eyes (58%) and decreasedby at least 2 lines in 2 eyes (17%). mean cmt at final examination was 315}95 (mu)m,which was significantly less than its preoperative value of 467}107 (mu)m (p=0.004).complications included vitreous hemorrhage in 2 and cataract progression in 5 eyes.conclusion: ppv with ilm peeling for refractory diffuse dme seems to reducemacular thickness, but does not significantly improve visual acuity as observed afteran intermediate-term follow up of about 6 months.