Should We Consider Pars Plana Vitrectomy in the Primary Treatment of Diabetic Macular Edema?

Diabetic macular edema (DME) is the most common cause of moderate visual loss in diabetic patients. The current treatment of choice for DME is anti-VEGF treatment. Even though recent clinical trials have shown that anti-VEGF treatment is superior to laser photocoagulation there are certain concerns regarding its sustainability over the long term. Most patients that undergo pharmacological inhibition with anti-VEGF agents need multiple monitoring visits that include OCT imaging and multiple injections. There is a theoretical concern regarding systemic thrombo-embolic events with chronic VEGF suppression. Pars plana vitrectomy (PPV) by increasing the vitreous cavity oxygenation, relieving vitreomacular traction and removing cytokines from the vitreous cavity may cause long term resolution of DME without the aforementioned concerns.