Vitrectomy with peeling of the inner limiting membrane for treating diabetic macular edema.

PURPOSE: to evaluate the results of pars plana vitrectomy with peeling of the inner limiting membrane (ILM stained with infracyanine green (IfCG) in 26 patients with diabetic macular edema, and to identify which factors are associated with a better postoperative visual outcome. PATIENTS AND METHODS: 26 patients with diabetic macular edema were included in the study. A pars plana vitrectomy with ILM peeling stained with IfCG was performed, in some cases combined with cataract surgery. In 22 patients the ILM was retained, examined with electron microscopy and compared with normal ILM's. Visual acuity and fundus examination were recorded several months after surgery. To determine which factors lead to the best postoperative results, patients were divided into different groups and compared. RESULTS: during surgery, a taut posterior hyaloid was found in 26 patients, which was successfully detached in all cases. ILM peeling within the vessel arcade succeeded in all patients. Postoperative examination showed improved visual acuity and decreased macular edema in 19 patients, unaltered visual acuity in 3 patients and decreased visual acuity in 4 patients. Comparison between different groups of patients revealed that young patients with recent vision loss and without previous macular laser treatment, had better postoperative results. Electron microscopical examination showed a more condensed ILM in diabetic patients, consisting of a layer of fine curled fibers. CONCLUSION: pars plana vitrectomy with peeling of the ILM stained with IfCG leads to good postoperative results in young diabetic patients with recent vision loss due to macular edema and without previous macular laser treatment.

ICG staining of the inner limiting membrane facilitates its removal during surgery for macular holes and puckers.

Formation of a macular hole is an uncommon idiopathic disease whereby a disruption of the neural retinal layer is formed at the foveal area. It has been suggested that tangential traction of the inner limiting membrane (ILM) on the neuroretina may contribute to the formation of a macular hole. Removal of the ILM has been associated with very high closure rates in macular hole surgery. However, since the inner limiting membrane is a transparent layer, it can be difficult to achieve complete removal from the underlying neural retina. Also in surgery for macular pucker formation, whereby growth of epiretinal tissue induces metamorphopsia, removal of the ILM may play a beneficial role. This paper describes a method facilitating the removal of the inner limiting membrane by staining it with indocyanine green.

Delayed diagnosis of retinoblastoma.

The aim of our study was to evaluate the age of the patient and the stage of retinoblastoma at diagnosis and to determine the time delay between the first symptoms noticed by proxy and the diagnosis of retinoblastoma. Therefore, thirty-three children between the age of zero and seven with the diagnosis of uni- or bilateral retinoblastoma were studied retrospectively. Thirty-one patients were diagnosed with advanced disease; two patients had small tumors. The mean time delay between the first clinical symptoms and the diagnosis of retinoblastoma was 3.2 months (range 2 months to 1 year). In our study most children with retinoblastoma were diagnosed with advanced disease. In some patients there was a significant time delay between the first symptoms and the final diagnosis of retinoblastoma. Better parental and environmental information regarding symptoms of retinoblastoma could help to assure earlier detection of tumors.