Observation on the efficacy of internal limiting membrane peeling for refractory diabetic macular edema

Objective To observe the efficacy of vitrectomy and retinal internal limiting membrane peeling for the treatment of refractory diabetic macular edema. Methods The data of 80 eyes of 80 patients with refractory diabetic macular edema from Jun.2014 to Nov.2015 were collected and retrospectively analyzed. They were divided randomly into two groups: group A and group B, every group included 40 eyes. All cases underwent intravitreal injection of ranibizumab first, and 7 days after injection 40 cases in group A underwent pars plana vitrectomy combined with panretinal photoeoagulation. In group B, 40 cases underwent surgery the same as that in group A and they received retinal internal limiting membrane peeling during vitrectomy. Preoperatively, the difference in age, gender, best corrected visual acuities (BCVA), central macular retinal thickness and intraocular pressure were not statistically significant between the two groups(P>0.05). The follow-up period was 6 months. Results At the end of follow-up, the postoperative BCVA(logMAR) was 0.46±0.23 in group B and 0.54± 0.19 in group A. The difference was statistically significant between the two groups (t=3.125, P=0.000). The postoperative BCVA of two groups improved obvious (P=0.000). At the last follow-up, the central macular retinal thickness in group B was (256.32±52.65)μm, which was lower than that in group A(271.65± 56.72)μm, and the difference was statistically significant (t=3.294, P=0.004). The cental macular retinal thickness of the two groups after surgery decreased significantly (P=0.000). Conclusion Intravitreal injection of ranibizumab combined with vitrectomy is an effective method for the treatment of refractory diabetic macular edema. During surgery combined with internal limiting membrane peeling can obviously improve the efficacy. Key words: Macular edema, diabetic, refractory; Vitrectomy; Peeling, internal limiting membrane