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Combination of ILM removal, vitrectomy can resolve macular edema

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NEW YORK — Removal of the internal limiting membrane while performing vitrectomy may offer patients with severe refractory macular edema a permanent resolution, according to a surgeon speaking here.

Ferenc Kuhn, MD, PhD, of Birmingham, Ala., and colleagues in Hungary conducted a review of 30 consecutive eyes that underwent vitrectomy with ILM peeling, followed for a mean of 7 months. All of the eyes had undergone previous laser therapy, but none received intraoperative laser therapy or steroid injections at the time of vitrectomy.

“The driving force is the unsuccessful previous treatment,” Dr. Kuhn said of the study’s inclusion criteria.

ILM removal resulted in complete resolution of the edema in 90% of the eyes and partial resolution in 10% without recurrence, Dr. Kuhn told attendees here at the meeting of the American Society of Retina Specialists.

Of the 30 eyes, 76% had improved visual acuity, with a mean improvement of 3.3 lines. For the 7% of patients in whom visual acuity worsened, cataract formation was responsible, Dr. Kuhn said.

Combined vitrectomy with ILM peeling may offer an alternative to laser treatment, which halts the progression of the edema but does not improve vision, and Kenalog (triamcinolone acetonide, Bristol-Myers Squibb) injections, which can be followed in the long term by relapses, Dr. Kuhn said. The effect of this procedure is slower, he added, but is more likely to result in permanent results.