Pars plana vitrectomy for full-thickness macular holes in patients with proliferative diabetic retinopathy and active fibrovascular proliferation

Abstract

Purpose of the Study: To study preoperative and postoperative optical coherence tomo-graphy features and the outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for full-thickness macular holes (MHs) associated with prolifera-tive diabetic retinopathy. Methods: The data from 14 eyes of 11 patients with full-thickness macular holes and active diabetic fibrovascular proliferation (FVP) with/without tractional retinal detachment who underwent pars plana vitrectomy and standard ILM peeling at Zarifa Aliyeva National Ophthalmology Centre in Baku were analysed. Bilateral surgery for diabetic MHs was performed in 27.3% of patients. The minimum follow-up duration was 6 months. Results: All eyes (100%) achieved type 1 macular hole closure, with residual macular subretinal fluid (SRF) present in 13 cases after surgery (92.9%). The SRF resolved gradually without any interventions. The incidence of SRF was 92.9% at 1 month, 85.7% at 3 months, 50% at 6 months, and 14.3% at 9 months (Cochran’s Q test, χ2 (4) =37.44, p<0.001). Visual acuity improved after surgery in 13 cases (92.9%), with a mean difference of 0.75 ±0.71 LogMAR between the preoperative and final values, rs=0.608, 95% BCa CI [0.037–0.969], p=0.021. Conclusion: The standard ILM peeling technique for full-thickness MHs in eyes with active diabetic fibrovascular proliferation can help restore the anatomy and function of the macula in diabetic patients. Close follow-up is important for unilateral cases. Residual SRF in the perifoveal area is detectable by OCT after surgery in patients with macular holes associated with diabetic tractional retinal detachment, and it usually resorbs gradually without any interventions.