| || |
William F. Mieler
LONDON Patients with
diffuse diabetic macular edema may benefit from pars plana
vitrectomy, but visual recovery is usually limited, according to a speaker
"A variety of options are proposed as first-line treatment for DME,
including focal photocoagulation and
intravitreal corticosteroid or anti-VEGF injections. However,
if the macular edema persists, surgery should be attempted," William F. Mieler,
MD, said at the
Euretina meeting here.
Small-gauge surgery now offers enhanced safety and better control in an
operation that may entail removing the internal limiting membrane. Surgery
facilitates the metabolic supply of the inner retina by enhanced diffusion from
the vitreous, also leading to improved microcirculation.
In addition, the amount of vitreous pigment epithelium-derived factor
and VEGF expression is decreased, resulting in a lessened stimulus for DME, Dr.
"OCT scans show definite improvement with a marked reduction
of the edema, but in contrast, visual recovery is variable and frankly poor in
some cases. Concomitant factors like macular ischemia, RPE atrophy and fibrosis
get in the way of good results," he said.
Surgery remains a worthwhile option nonetheless, Dr. Mieler said.
"Some patients do improve vision, the overall conditions of the retina
improve, the edema resolves and quality-of-life questionnaires are encouraging,
showing that most patients perceive a life quality improvement after surgery,"
- Disclosure: Dr. Mieler is on the advisory boards of Alcon, Allergan,
Genentech and QLT/Novartis.