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Vitrectomy may find use in treating unresponsive DME
 Anselm Kampik, MD |
LONDON — Diabetic macular edema with a tractional component that is not responding to anti-VEGF or laser therapy can be effectively treated with vitrectomy, according to a specialist.
"The effects of vitrectomy for DME have not been fully clarified in spite of 20 years of publications," Anselm Kampik, MD, said at the Euretina meeting here. "We are just starting to understand what makes this surgery work beyond the mechanical removal of the vitreous."
Epidemiological studies demonstrate that the incidence of posterior vitreous detachment is lower in patients with macular edema than in patients without macular edema.
"This means that attached vitreous is probably a risk factor for macular edema," Dr. Kampik said.
Vitrectomy removes tractional forces at the retinal surface and also addresses the ischemic component of DME.
"By reducing the oxygen consumption of the vitreous, it increases the oxygen level in the retina. At the same time, it removes the vitreous collagen on the retina, which has a potential high concentration of VEGF," Dr. Kampik said.
The success of surgery is enhanced by the intraoperative use of anti-VEGFs to reduce the edema and steroids to reduce the edema and visualize the vitreous. In addition, dyes are used to visualize the vitreoretinal interface and the internal limiting membrane, which aids in cleaning the vitreoretinal interface.
"In almost all cases, retinal thickness is reduced. Visual acuity improves in 40% of the cases, and effects are long-lasting," Dr. Kampik said.
- Disclosure: Dr. Kampik has no relevant financial disclosures.