Therapeutic Effect Of Triamcinolone Acetonide Assisted Internal Limiting Membrane Peeling For Diabetic Macular Edema

Objective: To investigate the change on anatomy and function of macular after pars plana vitrectomy (PPV) with Triamcinolone acetonide (TA) assisted internal limiting membrane (ILM) peeling for diabetic macular edema, evaluate the efficacy of the surgery and analyze the factors which might predict the visual outcome.Methods: A prospective, self-comparative, interventional case series of 19 patients (19eyes) with diabetic macular edema who completed 6 to 12 months of follow-up. We performed pars plana vitrectom with TA assistant internal limiting membrane peeling on the 19 patients, and monitored the thickness of macular through optical coherence tomography (OCT) and the best corrected visual acuity (BCVA), analyze the relative factors which might affect the visual outcome.Results:1.The change on macular fovea thickness: The postoperative macular fovea thickness had significant difference (P<0.01) compared with the preoperative fovea thickness at every observation point during the follow up. At 6 months post operation, the fovea thickness decreased to 168.0±22μm.2.The change on visual acuity: The postoperative LogMAR had significant difference (P<0.01) compared with the preoperative LogMAR at every observation point during the follow up. At 6 months post operation, the LogMAR was 0.83±0.25, and the BCVA improved 1 line in 2 patients (10.5%), improved≥2 lines in 14 patients (73.7%), improved<1 line in 3 patients.3.The analyses of relative factors might affect the visual outcome.(1) The duration of macular edema was positively correlated to the BCVA outcome (r=0.652, P=0.002); and the preoperative macular fovea thickness was positively correlated to the BCVA outcome (r=0.690, P=0.001).(2) There were no correlations between the age, duration of diabetes, preoperative LogMAR, postoperative fovea thickness and the LogMAR outcome.Conclusions:1.PPV with ILM peeling can be an effective treatment to improve the macular edema and visual acuity.2. TA can make the ILM peeling easier and safer.3. There are correlations between the duration of diabetic macular edema as well as preoperative macular fovea thickness and VA outcome.