Vitrectomy for diabetic macular edema associated with a taut premacular posterior hyaloid

Diabetic macular edema represents an important cause of visual loss in patients with diabetes. Although the pathophysiology of diabetic macular edema is unknown, various demographic, metabolic, and systemic factors have been implicated. More recently, the role of the posterior vitreomacular relationship has been evaluated, and studies suggest that posterior vitreous separation confers a protective effect on the development of diabetic macular edema. Furthermore, vitreomacular separation occurring in eyes with diabetic macular edema may facilitate spontaneous resolution of the edema and improvement in visual acuity. In a subset of patients, diffuse diabetic macular edema can result from a taut and condensed posterior hyaloid and often responds poorly to focal or grid-pattern laser photocoagulation. Previous studies have reported favorable results following vitrectomy and peeling of the posterior hyaloid in such cases.