The role of vitreous and vitreoretinal interface in the management of diabetic macular edema

Bernardete Pessoa

Bernardete Pessoa, a specialist in Ophthalmology, integrates the Surgical Retina and Ocular Trauma section of the Department of Ophthalmology of CHUPorto.
She got her Ph.D. in Medical Sciences at ICBAS-UP in January 2022, under the supervision of Professor João Nuno Melo Beirão.


What was the main goal of this study? 

The purpose of this research was to clarify the role of the vitreous in diabetic macular edema (DME), a multifactorial disease and leading cause of vision loss among working-age adults in developed countries. The vitreous is an unbalanced deposit of pathogenic/inflammatory, neuroprotector/anti-inflammatory molecules mostly produced by the retina and it is embedded.

What were the main variables in study?

Humoral vitreous biomarkers, vitreomacular interface (VMI), and the role of retinal and choroidal imaging biomarkers in response to EMD treatment in vitrectomized (VIT) and non-VIT eyes were among the factors studied.

What are the main study results?

Increased vitreous levels of IL-6, IL-8, MIG (CXCL9), and IP-10 (CXCL10) showed the highest post-vitrectomy prognostic and DR severity prediction capabilities, and raised levels of IL-8 and IP-10 may indicate DR worsening before further functional compromise.
Widefield-optical coherence tomography (widefield-OCT) emerged as a possible new gold standard to determine the vitreous state.

Focal vitreous-macular adhesion release should be addressed when no response is observed to intravitreal therapy (IVT).
VIT eyes are more prone to DR damage due to advanced inner retina neurodegeneration and reduced sensitivity to standard anti-VEGF IVT.
Subretinal fluid in anti-VEGF non-responders was associated with an increased risk of poor response to corticosteroids and need for combined therapy, particularly in non-VIT eyes.
When effective, anti-VEGF IVT seems to improve choroidal and retinal perfusion.
Corticosteroids can independently halt diabetic retinopathy (DR) neurodegenerative process and are preferred treatment options for DME in VIT.
s with negative functional prognostic factors (anterior-posterior vitreous-macular traction, VIT) and potential reversible stages (with lower inner nuclear layer retinal thickness/number of cysts or mild DR) should be treated earlier.

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