title: Systemic factors influence the prognosis of diabetic macular edema after pars plana vitrectomy with internal limiting membrane peeling.
abstract: BACKGROUND
  To evaluate the prognostic factors for the best-corrected visual acuity (BCVA) and foveal average retinal thickness after vitrectomy with internal limiting membrane (ILM) peeling for diabetic macular edema.
  
  
  METHODS
  Retrospective, single-center study.
  
  
  METHODS
  This study involved 31 eyes of 27 patients who had undergone vitrectomy with ILM peeling between January 2005 and March 2008.
  
  
  METHODS
  Relationships between preoperative systemic or ocular factors and BCVA or foveal average retinal thickness before and 6 months after the operation were evaluated.
  
  
  METHODS
  BCVA and foveal average retinal thickness before and 6 months after the operation.
  
  
  RESULTS
  The mean logarithm of the minimum angle of resolution improved from 0.84 ± 0.64 (mean ± standard deviation) preoperatively to 0.64 ± 0.38 six months postoperatively (p = 0.393). Foveal average retinal thickness significantly improved from 473 ± 146 µm preoperatively to 318 ± 108 µm 6 months after the operation (p < 0.0001). Preoperative foveal average retinal thickness was significantly thicker with cardiovascular disease or cerebral infarction (p = 0.0019) or cystoid macular edema (p = 0.0028), while preoperative BCVA was significantly lower when an epiretinal membrane (p = 0.042) was present. Foveal average retinal thickness at the 6-month follow-up was significantly thicker when patients had a higher body mass index (p = 0.0088), were not on dialysis (p = 0.012), or did not have proliferative diabetic retinopathy (p = 0.013). BCVA at the 6-month follow-up was significantly lower in the group with no history of diabetes treatment until diabetic retinopathy was found (p = 0.023) and in patients with a higher preoperative glycosylated hemoglobin (p = 0.033).
  
  
  CONCLUSIONS
  Preoperatively, BCVA and foveal average retinal thickness were primarily associated with ocular factors, while they were strongly associated with systemic factors, postoperatively. Ocular factor improvements may be related to the surgical procedure.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Yamada
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Suzuma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kumagami
authors.forename: Azusa
authors.initials: A
authors.lastname: Fujikawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Kitaoka
mesh_terms: D001485:Basement Membrane / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000601:surgery*; D019773:Epiretinal Membrane / Q000601:surgery; D005260:Female; D006801:Humans; D008269:Macular Edema / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012160:Retina / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy