title: Surgical treatment for severe diabetic macular edema with massive hard exudates.
abstract: OBJECTIVE
  Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation.
  
  
  METHODS
  The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded.
  
  
  RESULTS
  All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye).
  
  
  CONCLUSIONS
  Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema.
authors.affiliation: Ophthalmological Department, National Taiwan University Hospital, Taipei.
authors.forename: C M
authors.initials: CM
authors.lastname: Yang
mesh_terms: D000368:Aged; D048909:Diabetes Complications; D003930:Diabetic Retinopathy / Q000473:pathology / Q000601:surgery*; D005122:Exudates and Transudates; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D017075:Laser Coagulation; D008269:Macular Edema / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy