DECREASING OUTER RETINA TRAUMATISM OF INTERNAL LIMITING MEMBRANE PEELING IN DIABETIC EYES WITH FOVEAL SPARING TECHNIQUE

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PURPOSE: To evaluate the effect on outer retina integrity of foveal sparing (FS) internal limiting membrane peeling compared with standard internal limiting membrane peeling on proliferative diabetic retinopathy eyes affected by diabetic macular edema and epiretinal membrane. METHODS: Eyes diagnosed with proliferative diabetic retinopathy, diabetic macular edema, and epiretinal membrane eligible for vitrectomy were prospectively recruited and randomly assigned to either FS group or no foveal sparing group. Ellipsoid zone (EZ) lesion size, EZ reflectivity, and external limiting membrane integrity and angular sign of Henle fiber layer hyperreflectivity were assessed preoperatively and 1 year postoperatively. RESULTS: Twelve (12) eyes and fifteen (15) eyes were included in FS and no foveal sparing group, respectively. The two groups showed no differences in terms of EZ lesion size ( P = 0.549), EZ reflectivity ( P = 0.657), and external limiting membrane integrity (0.999) at preoperative examination. A significant increase in EZ lesion size was noted in the no foveal sparing group between preoperative and postoperative examination ( P = 0.040), which was not present in FS group ( P = 0.862). Moreover, the no foveal sparing group showed a higher prevalence of angular sign of Henle fiber layer hyperreflectivity and a lower EZ reflectivity at follow-up compared with FS group ( P = 0.047 and P = 0.041, respectively). CONCLUSION: Vitrectomy with FS internal limiting membrane peeling may result in a better preservation of the Muller-photoreceptors complex in proliferative diabetic retinopathy complicated with diabetic macular edema and epiretinal membrane.

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