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Surgery plays role in treatment of diffuse DME
 William F. Mieler |
LONDON — Patients with diffuse diabetic macular edema may benefit from pars plana vitrectomy, but visual recovery is usually limited, according to a speaker here.
"A variety of options are proposed as first-line treatment for DME, including focal photocoagulation and intravitreal corticosteroid or anti-VEGF injections. However, if the macular edema persists, surgery should be attempted," William F. Mieler, MD, said at the Euretina meeting here.
Small-gauge surgery now offers enhanced safety and better control in an operation that may entail removing the internal limiting membrane. Surgery facilitates the metabolic supply of the inner retina by enhanced diffusion from the vitreous, also leading to improved microcirculation.
In addition, the amount of vitreous pigment epithelium-derived factor and VEGF expression is decreased, resulting in a lessened stimulus for DME, Dr. Mieler said.
"OCT scans show definite improvement with a marked reduction of the edema, but in contrast, visual recovery is variable and frankly poor in some cases. Concomitant factors like macular ischemia, RPE atrophy and fibrosis get in the way of good results," he said.
Surgery remains a worthwhile option nonetheless, Dr. Mieler said.
"Some patients do improve vision, the overall conditions of the retina improve, the edema resolves and quality-of-life questionnaires are encouraging, showing that most patients perceive a life quality improvement after surgery," he said.
- Disclosure: Dr. Mieler is on the advisory boards of Alcon, Allergan, Genentech and QLT/Novartis.
