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PurposeTo describe the intraretinal microstructure using serial spectral domain optical coherence tomography (SD-OCT) preceding and following pars plana vitrectomy and delamination of fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR).MethodsThis retrospective, interventional case series includes 28 eyes. Outcome measures included LogMAR distance best-corrected visual acuity (BCVA), SD-OCT integrity of photoreceptor inner and outer segments junction (IS/OS), and integrity of external limiting membrane (ELM).ResultsPre-operative central macular thickness (CMT) was significantly correlated with the final post-operative LogMAR BCVA (Pearson's coefficient r=0.89; P=0.001). The eyes were categorised into three groups based on post-operative IS/OS integrity (group 0: IS/OS intact; group 1: IS/OS irregular but not completely disrupted; group 2: IS/OS completely disrupted). Mean BCVA improved significantly in group 0 (n=9) from 1.13±0.75 preoperatively to 0.34±0.21 (Student's t-test: P=0.06), in group 1 (n=10) the BCVA improved from 0.88±0.56 to 0.58±0.31 (Student's t-test: P=0.053) and in group 2 (n=9) the BCVA improved from 1.64±0.53 to 1.53±0.75 (Student's t-test: P=0.652).IS/OS integrity and ELM integrity at 3 months post operatively, were significantly and positively correlated with final BCVA (Pearson's coefficient: r=0.83, P<0.001 and r=0.72, P<0.001, respectively).ConclusionsPre-operative CMT and post-operative disruption of the IS/OS and ELM are useful prognostic indicators in fibrovascular delamination surgery for patients with PDR.

Objectives: This review discusses the evolution of the treatment of diabetic macular oedema and gives helpful guidelines in the treatment of diabetic macular oedema based on available evidence to date., Methods: A literature search of all English articles from the Medline and Cochrane database was performed. The search was limited to only English randomised controlled clinical trials in humans. Overall, 93 articles were cited from 1979 to 2007. Of these, 31 articles corresponded to subject matter. Studies were evaluated on a standardised data extraction form and tabulated for easy review., Results: There is good evidence that laser treatment preserves vision in eyes with diabetic macular oedema (DMO). However, laser is a potentially destructive form of treatment which may be of greater benefit in combination with newer forms of treatment such as intravitreal steroid or intravitreal antiangiogenic agents. Current evidence does not support a clear benefit for surgical intervention in DMO., Conclusions: Although laser treatment remains the cornerstone of treatment in diabetic macular oedema, the literature is beginning to support combination therapy. Using one or two intravitreal injections to reduce central macular thickness followed by focal or grid laser to give a sustained response may offer an alternative to treatment in DMO.

Steroid treatments for diabetic macular edema ( DME) include intravitreal Triamcinolone Acetonide ( IVTA) or subtenon Triamcinolone Acetonide ( STTA), the Dexamethasone 0.7 mg implant (Ozurdex, Allergan) and the Fluocinolone 190 µg implant (Iluvien, Alimera). Most IVTA studies in vitrectomized eyes have too many confounders including additional treatments such as macular laser or anti- VEG injections, variable outcome measures and follow up times. Furthermore, IVTA was usually given either at the time of pars plana vitrectomy ( PPV) to better visualize the vitreous, or at the end of PPV and sometimes combined with an anti- VEGF. STTA data are based on small non-randomized studies with short-term follow up. Whilst some studies have shown limited benefit, studies that compared vitrectomized and non-vitrectomized eyes found no difference in VA. Current data based on the Ozurdex implant in vitrectomised eyes found short-term benefit for both visual acuity ( VA) and macular thickness. No data is available at the present time for the use of the Iluvien implant for DME in previously vitrectomized eyes. Randomized controlled data are lacking to evaluate the role of steroids for the management of DME in the vitrectomized eye. [ABSTRACT FROM AUTHOR]