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EFFICACY OF SURGICAL REMOVAL OF THE INTERNAL LIMITING MEMBRANE IN DIABETIC CYSTOID MACULAR EDEMA

KIMURA, TETSUSHI; KIRYU, JUNICHI; NISHIWAKI, HIROKAZU; OH, HIDEYASU; SUZUMA, KIYOSHI; WATANABE, DAISUKE; KURIMOTO, MASAFUMI; TAKAGI, HITOSHI

Original Articles
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Purpose: To evaluate the efficacy of surgical removal of the internal limiting membrane (ILM) in diabetic cystoid macular edema (CME).

Methods: Prospective, noncomparative, interventional case series including 21 eyes of 18 consecutive patients with diabetic CME. Vitrectomy with separation of the posterior hyaloid and induction of posterior vitreous detachment had been performed previously on nine eyes. Pars plana vitrectomy for removal of the ILM was performed.

Results: CME resolved in eyes that underwent initial vitrectomy and in those with long-standing (>1 year) CME after previous vitrectomy. Postoperative best-corrected visual acuity improved by ≥2 lines of a Snellen equivalent in 14 eyes (67%) (P < 0.01). The mean foveal thickness (distance between the inner retinal surface and the retinal pigment epithelium) decreased from 553 μm to 221 μm at 4 weeks (P < 0.001). No recurrences or deterioration of CME was observed during the entire follow-up period (mean, 17.8 months; range, 8–34 months).

Conclusion: Surgical removal of the ILM might be an effective procedure for reducing CME in patients with diabetes. A prospective, randomized, controlled study is necessary to further evaluate the efficacy of the procedure.

Diabetic cystoid macular edema (CME) in eyes undergoing initial vitrectomy, as well as long-standing CME after previous vitrectomy resolved following removal of the internal limiting membrane (ILM). ILM removal might be an effective surgical procedure for reducing CME in patients with diabetes.

From the Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Science, and Culture of the Japanese Government.

Presented in part at the American Academy of Ophthalmology Annual Meeting; Orlando, Florida; October 2002.

The authors have no financial interest in any aspect of this study.

Reprint requests: Hitoshi Takagi, MD, PhD, Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto 606–8397, Japan; e-mail: hitoshi@kuhp.kyoto-u.ac.jp

© The Ophthalmic Communications Society, Inc.