Concurrent vitrectomy with phacoemulsification for subclinical diabetic macular edema: a long-term comparative study.

PURPOSE: To determine whether adding pars plana vitrectomy (PPV) to phacoemulsification and intraocular lens implantation (PEI) promotes long-term macular stability in eyes with subclinical diabetic macular edema (DME), defined as fluorescein angiography–positive macular leakage without optical coherence tomography (OCT)–evident center-involving macular edema (CI-ME).

METHODS

We conducted a retrospective study including 79 eyes with subclinical DME; 35 eyes underwent PPV with PEI (PPV-PEI), and 44 eyes underwent PEI alone. Outcomes were assessed at baseline, 1 year, and the final follow-up visit (mean follow-up > 6 years), including best-corrected visual acuity (BCVA), central macular thickness (CMT), CI-ME, and epiretinal membrane (ERM) formation.

RESULTS

Baseline CMT was higher in PPV-PEI than in PEI (p = 0.028), whereas baseline BCVA was comparable. BCVA improved at 1 year in both treatments (both p < 0.001) and remained similar at the final visit. In PPV-PEI, CMT increased transiently at 1 year (p < 0.001 vs. baseline) and then decreased toward baseline by the final visit (p = 0.005 vs. 1 year), whereas PEI showed persistently elevated CMT (p < 0.001 at 1 year; p = 0.017 at final). Final OCT-evident CI-ME tended to be less frequent in PPV-PEI (11.4%) than in PEI (29.5%). Within PPV-PEI, internal limiting membrane peeling was associated with fewer ERMs (p = 0.012) and independently associated with lower final CMT (p = 0.039).

CONCLUSION

Adding PPV to PEI was associated with preserved BCVA and improved long-term macular stability in eyes with subclinical DME.