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Vitrectomy useful in diabetic macular edema, but realistic patient expectations needed
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PUNTA DEL ESTE, Uruguay — Vitrectomy may help patients with diabetic macular edema when it is performed at an appropriate time and with new techniques, a surgeon said here. However, patients must understand that visual acuity may not improve with anatomic resolution, he noted.
J. Fernando Arevalo, MD, discussed his technique for using triamcinolone acetonide to stain membranes to be removed, along with other pearls for surgery, at the Curso Regional Panamericano.
"What do we want when we do vitrectomy in diabetic patients?" he asked. "Essentially, improved oxygenation to cleanse the cavity of VEGF to restore the retinal function and to recover or at least try to improve ... visual acuity."
Dr. Arevalo explained that he uses optical coherence tomography to identify the membranes at the level of the macula that require removal. He then stains those membranes with intravitreal triamcinolone.
"We inject triamcinolone ... to identify not only the vitreous remains but the whole cortical vitreous to the posterior hyaloid that may be removed much more easily when it's stained with triamcinolone," he said. "When the membranes are stained with triamcinolone, it's much easier to identify the structures and carry out a conventional bimanual technique."
Although this tip can ease the surgery and anatomic improvement, Dr. Arevalo warned that surgeons should not operate on patients with visual acuity worse than 20/400 as their outcomes will often be poor.
"We generally operate on [patients with visual acuities] between 20/40 and 20/400," he said. "We must also explain to the patient that surgery is basically to restore the anatomy and that often we obtain some improvement of visual acuity, but we shouldn't create false expectations as these anatomical improvements do not always correlate with visual acuity."