Which DME patients benefit from vitrectomy?

Vitrectomy should only be used for patients with diabetic macular oedema (DME) who also display signs of vitreomacular traction, according to study results published in the October issue of Eye.

D.A.H. Laidlaw of the Department of Ophthalmology, St Thomas' Hospital, London, UK conducted a literature review to establish the best treatment method for DME.

He found that although vitrectomy is commonly believed to relieve vitreomacular traction in DME patients, it is also associated with transvitreal oxygenation and increased diffusion of growth factor away from the premacular retina. Although Dr Laidlaw contested the rigour of much of the literature he reviewed, he identified a strong indication that vitrectomy improves visual acuity and reduces macular thickness in DME patients; this suggestion is not supported by the five published trials, which were all small, randomized and controlled, that Dr Laidlaw reviewed, although in patients displaying OCT or clinical signs of traction, vitrectomy was associated with a modest improvement in DME symptoms.

Despite the discord on the efficacy of vitrectomy for DME, Dr Laidlaw concluded that this procedure has value when treating DME patients with clinical signs of traction.