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Surgery plays role in DME cases unresponsive to pharmacotherapy
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VIENNA, Austria — Vitrectomy may still have a role in treating diabetic macular edema in patients who do not respond to treatment with anti-VEGFs or steroids, according to a specialist.
“Vitrectomy may be an option for nonresponders to pharmacological therapies,” Anat Loewenstein, MD, said at the Advanced Retinal Therapy meeting, citing studies showing that a proportion of patients on such therapies have poor gain of vision or lose vision.
Anat Loewenstein
“Some of these patients have obvious vitreomacular traction as detected on clinical examination and [optical coherence tomography],” she said.
Beneficial effects of vitrectomy on DME come from the release of traction, decrease in cytokines and improved oxygenation. Several reports show that edema is more than twice as likely to spontaneously resolve in eyes with vitreomacular separation than in eyes with vitreomacular adhesion, for which pharmacological vitreolysis has great potential, Loewenstein said.
Furthermore, novel techniques allow a safe approach to surgery. For example, internal limiting membrane (ILM) peeling may be beneficial in DME cases, because the thicker ILM is a barrier to transretinal fluid circulation. Removal may contribute to edema resolution because it maximizes oxygen diffusion to the retina and prevents VEGF accumulation, she said.
Even though good anatomic results may not correspond to significant gain in vision, a recent study found that glycemic control may play an important role in determining macular thickness and BCVA after surgery.
Disclosure: Loewenstein is a consultant to Allergan, Bayer, Notal Vision, Novartis and Teva.