Retinal ellipsoid zone/external limiting membrane restoration after diabetic macular edema treatment

Purpose The aim of this study was to determine which clinically significant diabetic macular edema treatment modality results in early restoration of the ellipsoid zone and external limiting membrane (EZ/ELM). Patients and methods This was a retrospective study where the medical records of patients with type 2 diabetes mellitus and clinically significant diabetic macular edema were reviewed. Patients who had valid scans before treatment and 6 months after treatment were included. Disruption of EZ/ELM was graded and compared. Patients were divided into six groups according to the treatment received: group A received argon laser treatment; group B received micropulse diode laser treatment; group C received antivascular endothelial growth factor (anti-VEGF) treatment; group D received anti-VEGF+laser therapy; group E received triamcinolone acetonide injection (TAI); and group F received TAI+laser therapy. Results A total of 293 eyes of 200 patients were included (group A: 47, group B: 40, group C: 52, group D: 54, group E: 51, and group F: 49 eyes). Improvement in EZ/ELM integrity was 38.3% in group A, 45% in group B, 59.6% in group C, 37% in group D, 54.9% in group E, and 44.9% in group F. The difference between groups A and B was not statistically significant (P=0.3). The differences between group A and groups C, D, and E were statistically significant (P=0.002, 0.006, and 0.02, respectively). The difference between groups A and F was not significant (P=0.2). The difference between groups C and D was significant (P=0.001), whereas the difference between groups E and F was not significant (P=0.15). Conclusion Anti-VEGF monotherapy showed the highest percentage of early EZ/ELM restoration. Argon laser alone or argon laser combined with anti-VEGF delayed EZ/ELM healing. Micropulse laser therapy was equivalent to argon laser therapy. TAI results were comparable with anti-VEGF results. Laser addition did not compromise TAI results.

Abstract licence: CC BY-NC-SA

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