Diabetic macular edema and vitreoretinal surgery: a review

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Abstract

Diabetic retinopathy, including its complication diabetic macular edema, is considered a socially significant disease of our time. The pathogenesis of these conditions is complex and remains the subject of investigation. There are two forms of diabetic macular edema — intracellular and extracellular. Diabetic intracellular edema develops as a result of intracellular accumulation of sorbitol, lactate, and phosphates, caused by metabolic disturbances in hyperglycemia. Extracellular edema is associated primarily with damage to the blood–retinal barrier, which is accompanied by increased fluid inflow into the tissue and decreased clearance as diabetes progresses. The loss of the protective function of the inner blood–retinal barrier occurs mainly due to damage to the cells and intercellular junctions comprising it. The outer blood–retinal barrier is affected by damage to the external limiting membrane. Currently, the gold standard for the treatment of diabetic macular edema is the use of angiogenesis inhibitors. At the same time, with the development of vitreoretinal surgery, the effect of this method on diabetic macular edema is being actively studied. In addition, new vitreoretinal surgical techniques are being proposed to correct it. However, the results of surgical treatment vary according to different authors. The preservation of the ellipsoid zone and the external limiting membrane are considered as predictors of its effectiveness.

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About the authors

Rinat R. Fayzrakhmanov

National Medical and Surgical Center named after N.I. Pirogov

Email: rinatrf@gmail.com
ORCID iD: 0000-0002-4341-3572
SPIN-code: 1620-0083

MD, Dr. Sci. (Medicine)

Russian Federation, Moscow

Oleg A. Pavlovskiy

National Medical and Surgical Center named after N.I. Pirogov

Email: olegpavlovskiy@yandex.ru
ORCID iD: 0000-0003-3470-6282
SPIN-code: 6781-1504

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Andrei O. Martynov

National Medical and Surgical Center named after N.I. Pirogov

Email: andrey_099098@mail.ru
ORCID iD: 0009-0007-6353-6549
SPIN-code: 8355-9604
Russian Federation, Moscow

Michael A. Lukinykh

Ophthalmological Center "Vision"

Email: 97mikol97@gmail.com
ORCID iD: 0009-0003-9015-7158
SPIN-code: 3804-9805
Russian Federation, Moscow

Elena E. Vaganova

National Medical and Surgical Center named after N.I. Pirogov

Email: vaganova.e.e@gmail.com
ORCID iD: 0000-0003-2234-0914
SPIN-code: 5881-8822
Russian Federation, Moscow

Violetta A. Bogdanova

National Medical and Surgical Center named after N.I. Pirogov; Eye Clinic "Bio Absolut"

Author for correspondence.
Email: violbogdanova@gmail.com
ORCID iD: 0000-0002-0353-9074
SPIN-code: 4855-2730
Russian Federation, Moscow; Kovrov

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2. Fig. 1. Preoperative (a) and postoperative (b) optical coherence tomography: a, intact external limiting membrane (arrowheads); b, 22 months after surgery, the external limiting membrane remained intact (arrowheads). Adapted from [52]. © D. Ivastinovic et al., 2021. Distributed under CC BY 4.0.

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3. Fig. 2. Preoperative (a) and postoperative (b) optical coherence tomography: a, complete disruption of the external limiting membrane (grade 3) in the fovea. Arrowheads indicate the external limiting membrane outside the center; b, 21 months after surgery. Disruption of the external limiting membrane in the center. Arrowheads indicate the intact external limiting membrane outside the center. Adapted from [52]. © D. Ivastinovic et al., 2021. Distributed under CC BY 4.0.

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