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    Vitrectomy offers a viable therapeutic option for DME


    For select patients

    He suggested that with the availability of spectral-domain optical coherence tomography (SD-OCT), which enables preoperative determination of the integrity of the outer retina, patients with potential to gain visual acuity can be selected for PPV.

    Figure 2. These images show the different visual results obtained after thinning the retina with vitrectomy. The top (before and after) images of the retina show good visual result if patients start with intact outer retina (by SD-OCT). The bottom (before and after) images of retina show poor visual results (20/200 only improved to 20/160, in spite of good anatomical result) if patients start with damaged outer retina by SD-OCT (Images courtesy of Maurice Landers III, MD)

    “We now have evidence that the integrity of the outer retinal layers correlates with visual acuity in patients with DME,” Dr. Landers explained. “There is a correlation between the previtrectomy integrity of the external limiting membrane and ellipsoid zone and the potential for functional improvement with improvement in DME.”

    Dr. Landers noted that the techniques and instrumentation for PPV have advanced significantly since the procedure was first introduced almost 50 years ago. It has an acceptable risk profile compared with anti-VEGF therapy, considering rates of major complications.

    “There is an about 1% incidence of sight-threatening retinal detachment with PPV and an about 1% cumulative three-year incidence of endophthalmitis with intravitreal injections,” Dr. Landers said.

    Maurice Landers III, MD

    e. [email protected]

    This article is based on a presentation given by Dr. Landers at the 2017 Retina World Congress. Dr. Landers has no relevant financial interests to disclose.


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