Pars plana vitrectomy with removal of posterior hyaloid face in treatment of refractory diabetic macular edema resistant to triamcinolone acetonide.
BACKGROUND
Triamcinolone acetonide (TA) has recently been used to treat diabetic macular edema (DME) but its effectiveness is limited.


METHODS
Three patients (three eyes) with unresolved diffuse DME who did not respond to a posterior sub-Tenon's injection of TA underwent vitrectomy.


METHODS
Intraoperatively, it was found that all of the eyes had a posterior hyaloid face that was adherent to a large area of the posterior pole retina, although this had not been detected by slit-lamp biomicroscopy or optical coherence tomography. After vitrectomy and removal of the posterior hyaloid face, there was a significant reduction in the central macular thickness of all three eyes and an improvement in the visual acuity of the patients.


CONCLUSIONS
When TA treatment is not effective for DME, vitrectomy with the complete removal of the posterior hyaloid face, including removal of the internal limiting membrane, should be considered.
Higuchi
Akiko
A
Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
Ogata
Nahoko
N
Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan. ogata@takii.kmu.ac.jp.
Jo
Nobuo
N
Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
Wada
Mitsumasa
M
Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
Matsumura
Miyo
M
Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
D000368:Aged; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000187:drug effects / Q000473:pathology / Q000601:surgery*
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide