Surgical Treatment for Diabetic Macular Edema

Diabetic macular edema (DME) is defined as excess fluid accumulation within the retina in area, and when it centered on fovea most common cause of decreased visual acuity patients with diabetic retinopathy. The development closely related to duration diabetes, poor glycemic control, type 2 diabetes insulin therapy. first-line therapy has been intravitreal injection anti-vascular endothelial growth factors (VEGF). Other treatment modalities are corticosteroid focal laser photocoagulation. However, efficacy may decrease significantly over time, especially presence vitreomacular traction, tight posterior hyaloid, or epiretinal membrane (ERM). At this stage, pars plana vitrectomy (PPV) preferred an alternative method eyes chronic DME resistant injections. vitreous contains high amounts VEGF Angiotensin 2, which DME, cytokines such interleukin-6 ICAM-1. In addition, due enzymes, contains, causes cross-linking thickening collagen fibers its structure, causing adhesion traction macula. mechanism action can be explained by removing tractions. Vitrectomy also increase retinal oxygenation. Selection appropriate case important. undisturbed integrity outer layers including external limiting membrane(ELM) ellipsoid zone, no preoperative foveal ischemia, performing surgery early before ELM damaged, have found better postoperative gain. Further, prospective, randomized, controlled studies large series detailed parameters long follow-up evaluating surgical warranted.