Morphometry of surgically removed internal limiting membrane during vitrectomy in diabetic macular edema.
BACKGROUND
Histopathologic and morphometric analysis of the internal limiting membrane (ILM) in diabetic eyes was performed. The thickness of the ILM was correlated with the level of glycosylated hemoglobin (HbA(1C)) and other clinical factors.


METHODS
The prospective study involved 56 eyes of 52 diabetic patients with a mean age of 63 +/- 7.6 years. Vitrectomy with trypan blue-assisted ILM peeling was performed in the standard way. The mean follow-up period was 8.7 months (range 3-19 months). The ILM was fixed immediately after peeling in 2.5% glutaraldehyde and submitted for electron microscopic evaluation. The ILM was photographed at standard magnification (x5,000) with the scale of 1 microm in the shot.


RESULTS
Morphometric analysis demonstrated a significant thickening of the ILM in all eyes, with a mean thickness of the ILM of 3.61 +/- 1.22 microm. It was found that a higher thickness of the ILM is related to elevated HbA(1C) in both types of diabetes mellitus (DM) (p = 0.040). We also found significant dependence of ILM thickness in relation to duration of DM by comparison of men and women (p = 0.026), and a significant correlation between ILM thickness and the age of diabetic patients related to their gender (p = 0.029).


CONCLUSIONS
We confirmed increased thickness of the surgically peeled ILM and statistically significant correlations to elevated HbA(1C) in both types of DM, and to further clinical characteristics of case series. Morphometric and histopathologic analyses of the ILM contribute to more objective evaluation of the ultrastructure of the vitreomacular interface.
Department of Ophthalmology of the First Faculty of Medicine, Charles University in Prague and General Teaching Hospital, U Nemocnice 2, Prague 2, Czech Republic.
Jan
J
Kalvoda
Jaroslava
J
Dusková
Ales
A
Kubena
Ctibor
C
Povýsil
Bohdana
B
Kalvodová
D000367:Age Factors; D000368:Aged; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D003930:Diabetic Retinopathy / Q000097:blood / Q000473:pathology / Q000601:surgery*; D019773:Epiretinal Membrane / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008269:Macular Edema / Q000473:pathology / Q000601:surgery*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D013997:Time Factors; D014821:Vitrectomy
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human