Evaluation of Vitrectomy with Planned Foveal Detachment as Surgical Treatment for Refractory Diabetic Macular Edema with or without Vitreomacular Interface Abnormality

Figure 3

(a) Color fundus photo of a 59-year-old female who had vitrectomy done for refractory DME after failure of anti-VEGF (10 IVB and 3 IVA) to improve the edema. Upper OCT image and map showing CMT of 508 microns a year after the vitrectomy with BCVA of 0.05, totally disrupted ellipsoid zone and ELM. Lower OCT image and thickness map after 3 IVTA injections 3 months apart as a trial to improve the edema, CMT measuring 515 microns without VA gain and appearance of an ERM. (b) During surgery, ILM peeling was reattempted, and submacular BSS was injected to cover the whole area of the edema. (c) OCT of the macula 1 month postoperatively shows resolution of the edema with CMT 274 microns and BCVA of 0.1. (d) Red free photo 9.5 months postop. with thickness dropped further to 202 microns and BCVA still 0.1, probably due to the marked ELM and ellipsoid zone disruption.

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