title: Pars plana vitrectomy with removal of posterior hyaloid face in treatment of refractory diabetic macular edema resistant to triamcinolone acetonide.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Higuchi
authors.affiliation: Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan. ogata@takii.kmu.ac.jp.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Ogata
authors.affiliation: Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Jo
authors.affiliation: Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Wada
authors.affiliation: Department of Ophthalmology, Kansai Medical University, Moriguchi, Osaka, Japan.
authors.forename: Miyo
authors.initials: M
authors.lastname: Matsumura
mesh_terms: 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*
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide