Diabetic Maculopathy

Diabetic macular edema (DME) is a leading cause of visual loss in developed nations, and as the population with diabetes expands, the burden of DME will increase. Current treatments for DME are suboptimal because they have short duration and are time-consuming for patients, caregivers, and physicians and extremely expensive even for regimens with bevacizumab. Pars plana vitrectomy has been shown to reduce or resolve DME in a large percentage of patients. The sight-threatening complications of vitrectomy occur with approximately the same frequency as those with an extended series of intravitreal injections. The cost of vitrectomy to the patient or third-party payer, insurance companies or government, is approximately the same as that of a single year of off-label injections of bevacizumab, but it is generally only a small fraction of the cost of ranibizumab. Edema-resolving effects of vitrectomy are durable, intravitreal injection regimens that usually must be continued for years. The role of vitrectomy compared with other approaches in the management of DME remains uncertain as the potential benefits and risks have not been clearly defined in the context of long-term, adequately sized randomized clinical trials (RCT). Pars plana vitrectomy treatment of early DME must be studied carefully. It is reasonably likely that vitrectomy will prove as effective, safe, efficient, and considerably less expensive than the intravitreal injection therapies that are currently the standard of care in the United States and around the world for this widespread and growing problem.