PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edem a refractory to laser photocoagulation.DESIGN: Prospective, consecutive, interve ntional case series. METHODS: Diabetic patients with biomicroscopic, angiographi c, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for in clusion. Patients with biomicroscopic evidence of epiretinal membrane or taut po sterior hyaloid, previous vitreoretinal surgery, or active proliferative diabeti c retinopathy were excluded. The main outcome measures were macular thickness, a s measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS : PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six wo men; mean age=58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20%in eight of 11 eyes (mean preoperative thickness of 421 μm compare d with mean postoperative thickness of 188 μm; P=.007). Mean VA improved from 2 0/352 to 20/94 at 6 months (P=.002). By the most recent visit (range=6-20 month s postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in so me eyes with chronic diabetic macular edema unresponsive or unamenable to additi onal laser photocoagulation.
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