For select patients
He suggested that with the availability of spectral-domain optical coherence tomography (SD-OCT), which enables preoperative determination of the integrity of the outer retina, patients with potential to gain visual acuity can be selected for PPV.
“We now have evidence that the integrity of the outer retinal layers correlates with visual acuity in patients with DME,” Dr. Landers explained. “There is a correlation between the previtrectomy integrity of the external limiting membrane and ellipsoid zone and the potential for functional improvement with improvement in DME.”
Dr. Landers noted that the techniques and instrumentation for PPV have advanced significantly since the procedure was first introduced almost 50 years ago. It has an acceptable risk profile compared with anti-VEGF therapy, considering rates of major complications.
“There is an about 1% incidence of sight-threatening retinal detachment with PPV and an about 1% cumulative three-year incidence of endophthalmitis with intravitreal injections,” Dr. Landers said.