Combination of vitrectomy, IVTA, and laser photocoagulation for diabetic macular edema unresponsive to prior treatments; 3-year results.

OBJECTIVE

To evaluate the long-term effects of combined therapy of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation on diabetic macular edema (DME) unresponsive to prior treatment.

METHODS

Medical records of 46 eyes of 41 subjects who underwent sequential combined therapy consisting of vitrectomy, intravitreal triamcinolone, and macular laser photocoagulation for refractory DME of non-tractional origin were reviewed. Best-corrected visual acuity (BCVA), central subfield thickness (CST) of macula, and number of additional treatments were analyzed.

RESULTS

Forty eyes of 35 patients completed a 3-year follow-up. The mean (± SD) CSTs before and 6 months, 1 year, 2 years, and 3 years after the administration of combined therapy in these eyes were 499.1 ± 174.9, 224.2 ± 110.2, 273.4 ± 173.5, 237.5 ± 84.2 and 219.4 ± 66.6 µm, respectively (p < 0.001). The mean (± SD) logMAR BCVA before and 6 months, 1 year, 2 years, and 3 years after the combined therapy were 0.82 ± 0.32, 0.69 ± 0.40, 0.63 ± 0.39, 0.61 ± 0.46, and 0.55 ± 0.44, respectively (p < 0.001). Thirty-one of 40 eyes (77.5%) exhibited no recurrence of DME after the combined therapy. No visually significant complications other than progression of lens opacity and elevation of intraocular pressure were noted during the study period.

CONCLUSIONS

This study demonstrated the long-term stability and efficacy of the combined therapy described herein for the treatment of refractory DME.