First Author: V.Dzinic SERBIA
Co Author(s): M. Dzinic A. Oros
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to show the results of combined pars plana phacovitrectomy in patients with proliferative diabetic retinopathy, and macular traction who were treated with or without ILM peeling.
Clinical centre of Vojvodine, University Eye Clinic, Novi Sad, Serbia Private Eye clinic Dzinic, Novi Sad, Serbia
50 eyes (48 patients) were followed. In all patients PDR was diagnosed. Visual acuity (VA) ranges from light perception to 0,3. After complete examination which include visual acuity testing (Snellen chart), biomicroscopy, ophthalmoscopy, IOP and US, surgery was indicated. All patients received intravitreal injection of anti-VEGF (bevacizumab) 3-7 days before the surgery. Combined 23G 4 port phacovitrectomy was conducted with hydrophobic IOL implantation, posterior capsulorexis, bi manual removal of proliferations and epi-macular membrane removal. In patients with vitreal haemorrhage, localised proliferation and focal macular traction only proliferations were removed without ILM peeling. In patients with extensive proliferations which were covering entire posterior pole and extended towards periphery causing tractional retinal detachment, ILM was removed also. As a tamponade agent air or 1300 cst silicone oil was used. After the surgery all patients received local therapy of tobramycin-dexamethasone together with non-steroid anti-inflammatory eye drops during one month period. Follow up period was 24 months.
VA before surgery was light perception in 13 eyes, while the mean VA in the rest of 37 eyes was 0.09 (0.0083 - 0.3). In 14 eyes silicone oil as a tamponade agent was used and removed after 3-6 months after the surgery and in 36 eyes tamponade agent was air. In 26 eyes ILM was peeled primary. In 24 eyes in which ILM was not peeled in the first surgery after 9-12 months epi-macular membrane with significant macular traction was observed in 7 (29.2%) eyes in which additional surgery with ILM peeling was performed. Mean VA at the end of the follow-up period was 0.3 (0.03 - 0.6).
According to our study primary peeling of internal limiting membrane ILM has beneficial effect in preventing reoccurrence of epi-macular membrane in diabetic patients during follow-up period. Our results showed that in 29.2% of patents reoccurrence of membrane was observed and additional surgery was needed. Further investigations are needed in order to confirm safety and potential damage to the nerve fibre layer in order to establish ILM peeling as primary procedure.