[Surgical treatment of chronic macular oedema with a combination therapy].
BACKGROUND
The treatment of therapy-resistent chronic macular oedema remains a challenge. Therefore a combination therapy, consisting of medical, biological and mechanical components was assessed.


METHODS
A surgical treatment was performed in 35 eyes (34 patients) with chronic and therapy-resistant macular oedema, resulting from diabetic maculopathy (n = 25), vitreoretinal traction (n = 7) or following a retinal venous occlusion (n = 3). An intravitreal injection of bevacizumab was given on the day before surgery, consisting of pars plana vitrectomy with ILM peeling with Brilliant Blue G (BBG), as well as an air tamponade combined with postoperative prone positioning. The visual function and the central retinal thickness were measured in follow-up.


RESULTS
Functionally, the visual acuity could be stabilised to an average of 0.18 and macular oedema was reduced in most patients. Anatomically, a significant reduction in central macular thickness by 193 µm (29 %), from 598 µm to 405 µm (p < 0.001), and a regression in the intraretinal cystoid changes were observed. No significant complications occurred, whereas in 6 patients additional consecutive treatment was necessary.


CONCLUSIONS
A stabilisation of the visual acuity and an improvement in the structural retinal situation could be achieved by an elaborate combination therapy, based on a pharmacological, a biological and a mechanical approach. Long-term follow-up and consecutive supplementary treatments are necessary to ensure the functional stability.
Klinik für Augenheilkunde, Klinikum Frankfurt (Oder) GmbH.
D
D
Kolarov
Klinik für Augenheilkunde, Klinikum Frankfurt (Oder) GmbH.
A
A
Just
Klinik für Augenheilkunde, Klinikum Frankfurt (Oder) GmbH.
C
C
Wirbelauer
D000368:Aged; D000388:Air; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D002908:Chronic Disease; D003131:Combined Modality Therapy; D058450:Endotamponade / Q000379:methods*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D056888:Patient Positioning / Q000379:methods; D011292:Premedication / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab