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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-01-2019 | Review Article

Vitreous and intraretinal macular changes in diabetic macular edema with and without tractional components

Authors: Mario R. Romano, Davide Allegrini, Chiara Della Guardia, Stefano Schiemer, Immacolata Baronissi, Mariantonia Ferrara, Gilda Cennamo

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 1/2019

Abstract

Diabetic macular edema (DME) is still one of the main causes of visual impairment. Repeated intravitreal injections of ranibizumab are considered the gold standard treatment, but the efficacy in patients with prominent cystic characteristics remains uncertain. In diabetic retinas, the identification of both antero-posterior and, particularly, tangential tractions is crucial to prevent misdiagnosis of tractional and refractory DME, and therefore to prevent poor treatment outcomes. The treatment of tractional DME with anti-VEGF injections could be poorly effective due to the influence of a tractional force. Pars plana vitrectomy (PPV) is a surgical procedure that has been widely used in the treatment of diffuse and refractory DME. Anatomical improvement, although stable and immediate, did not result in visual improvement. PPV with internal limiting membrane (ILM) peeling for the treatment of non-tractional DME in patients with prominent cysts (> 390 μm) causes subfoveal atrophy, defined as “floor effect”. Epiretinal tangential forces and intraretinal change evaluation by SD-OCT of non-tractional DME are essential for determining appropriate management.

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Title: Vitreous and intraretinal macular changes in diabetic macular edema with and without tractional components
Authors: Mario R. Romano
Davide Allegrini
Chiara Della Guardia
Stefano Schiemer
Immacolata Baronissi
Mariantonia Ferrara
Gilda Cennamo
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 1/2019
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-018-4173-8

At a glance: The STEP trials

Springer Medicine

Vitreous and intraretinal macular changes in diabetic macular edema with and without tractional components

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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