The progress of vitreous surgery for diabetic macular edema_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhu Li ,  Chen Xiao

Department of Ophthalmology, Central Theater Command General Hospital of Chinese People's Liberation Army, Wuhan 430070, China;

Corresponding author：

Chen Xiao, Email: cxfn817@163.com

Keywords：

Diabetic retinopathy; Macular edema; Vitrectomy; Review

DOI：

10.3760/cma.j.cn511434-20190827-00266

Video：

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Abstract Full text Figures/Tables Video References Cited by

Diabetic macular edema (DME) is the main cause of visual impairment in patients with diabetic retinopathy (DR). Currently, the main treatment methods of DME include intravitreal injection of anti-VEGF drugs, glucocorticoids and laser photocoagulation, but there are still some patients who do not respond or respond poorly to non-surgical treatments. Clinical and basic studies have confirmed that the abnormality of the vitreous-retinal interface plays an important role in the pathogenesis of DME. Par plana vitrectomy (PPV) can relieve macular traction, clear the vitreous cavity VEGF and other inflammatory cytokines, increase the vitreous cavity oxygen concentration, improve retinal oxygen supply, reduce retinal thickness of traction and non-traction DME, and improve patients' vision. However, how to choose and apply PPV to treat DME in specific practice, and to further improve the efficacy of PPV, including the innovation of surgical technology, combined treatment and the choice of surgical timing, still needs more clinical studies to explore.

Citation： Zhu Li, Chen Xiao. The progress of vitreous surgery for diabetic macular edema. Chinese Journal of Ocular Fundus Diseases, 2020, 36(11): 906-909. doi: 10.3760/cma.j.cn511434-20190827-00266 Copy

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2.	Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic maeular edema by the European Society of Retina Specialists(EURETINA)[J]. Ophthalmologica, 2017, 237(4): 185-222. DOI: 10.1159/000458539.
3.	Bressler SB, Qin H, Beck RW, et al. Factors associated with changes in visual acuity and central subfield hickness at 1 year after treatment for diabetic macular edema with ranibizumab[J]. Arch Ophthalmol, 2012, 130(2): 1153-1161. DOI: 10.1001/archophthalmol.2012.1107.
4.	Stolba U, Binder S, Gruber D, et al. Vitrectomy for persistent diffuse diabetic macular edema[J]. Am J Ophthalmol, 2005, 140(3): 295-301. DOI: 10.1016/j.ajo.2005.03.045.
5.	Gandorfer A. Role of vitreous in diabetic macular edema[J]. Retina, 2012, 32(Suppl): S211-215. DOI: 10.1097/IAE.0b013e31825bc704.
6.	Sebag J, Buckingham B, Charles MA, et al. Biochemical abnormalities in vitreous of humans with proliferative diabetic retinopathy[J]. Arch Ophthalmol, 1992, 110(10): 1472-1476. DOI: 10.1001/archopht.1992.01080220134035.
7.	Lopes de Faria JM, Jalkh AE, Trempe CL, et al. Diabetic macular edema: risk factors and concomitants[J]. Acta Ophthalmol Scand, 1999, 77(2): 170-175. DOI: 10.1034/j.1600-0420.1999.770211.x.
8.	Tachi N, Ogino N. Vitrectomy for diffuse macular edema in cases of diabetic retinopathy[J]. Am J Ophthalmol, 1996, 8(1): 258-260. DOI: 10.1016/s0002-9394(14)72018-5.
9.	Lewis H, Abrams GW, Blumenkranz MS, et al. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction[J]. Ophthalmology, 1992, 99(5): 753-759. DOI: 10.1016/s0161-6420(92)31901-3.
10.	Jumper JM, Embabi SN, Toth CA, et al. Electron immunocytochemical analysis of posterior hyaloid associated with diabetic macular edema[J]. Retina, 2000, 20(1): 63-68. DOI: 10.1097/00006982-200001000-00012.
11.	Kishi S, Shimizu K. Clinical manifestations of posterior precortical vitreous pocket in proliferative diabetic retinopathy[J]. Ophthalmology, 1993, 100(2): 225-229. DOI: 10.1016/s0161-6420(93)31666-0.
12.	Spaide RF. Measurement of the posterior precortical vitreous pocket in fellow eyes with posterior vitreous detachment and macular holes[J]. Retina, 2003, 23(4): 481-485. DOI: 10.1097/00006982-200308000-00006.
13.	Fine BS. Limiting membranes of the sensory retina and pigment epithelium. an electron microscopic study[J]. Arch Ophthalmol, 1961, 66: 847-860. DOI: 10.1001/archopht.1961.00960010849012.
14.	Barile GR, Pachydaki SI, Tari SR, et al. The RAGE axis in early diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2005, 6(8): 2916-2924. DOI: 10.1167/iovs.04-1409.
15.	Abari E, Kociok N, Hartmann U, et al. Alterations in basement membrane immunoreactivity of the diabetic retina in three diabetic mouse models[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(3): 763-775. DOI: 10.1007/s00417-012-2237-8.
16.	Tamura K, Yokoyama T, Ebihara N, et al. Histopathologic analysis of the internal limiting membrane surgically peeled from eyes with diffuse diabetic macular edema[J]. Jpn J Ophthalmol, 2012, 56(3): 280-287. DOI: 10.1007/s10384-012-0130-y.
17.	Funatsu H, Yamashita H, Noma H, et al. Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema[J]. Am J Ophthalmol, 2002, 133(1): 70-74. DOI: 10.1016/s0002-9394(01)01269-7.
18.	Funatsu H, Noma H, Mimura T, et al. Association of vitreous inflammatory factors with diabetic macular edema[J]. Ophthalmology, 2009, 16(1): 73-79. DOI: 10.1016/j.ophtha.2008.09.037.
19.	Haller JA, Qin H, Apte RS, et al. Vitrectomy outcomes in eyes with diabetic macular edema and itreomacular traction[J]. Ophthalmology, 2010, 117(6): 1087-1093. DOI: 10.1016/j.ophtha.2009.10.040.
20.	Pessoa B, Dias DA, Baptista P, et al. Vitrectomy outcomes in eyes with tractional diabetic macular edema[J]. Ophthalmic Res, 2019, 61(2): 94-99. DOI: 10.1159/000489459.
21.	Kumagai K, Furukawa M, Ogino N, et al. Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema[J]. Retina, 2009, 29(4): 464-472. DOI: 10.1097/IAE.0b013e31819c632f.
22.	Bonnin S, Sandali O, Bonnel S, et al. Vitrectomy with internal limiting membrane peeling for tractional and nontractional diabetic macular edema: long-term results of a comparative study[J]. Retina, 2015, 35(5): 921-928. DOI: 10.1097/IAE.0000000000000433.
23.	Funatsu H, Yamashita H, Nakamura S, et al. Vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor are related to diabetic macular edema[J]. Ophthalmology, 2006, 113(2): 294-301. DOI: 10.1016/j.ophtha.2005.10.030.
24.	Stefánsson E. Ocular oxygenation and the treatment of diabetic retinopathy[J]. Surv Ophthalmol, 2006, 51(4): 364-380. DOI: 10.1016/j.survophthal.2006.04.005.
25.	Simpson AR, Dowell NG, Jackson TL, et al. Measuring the effect of pars plana vitrectomy on vitreous oxygenation using magnetic resonance imaging[J]. Invest Ophthalmol Vis Sci, 2013, 54(3): 2028-2034. DOI: 10.1167/iovs.12-11258.
26.	Stefánsson E. Physiology of vitreous surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2009, 247(2): 147-163. DOI: 10.1007/s00417-008-0980-7.
27.	Lee SS, Ghosn C, Yu Z, et al. Vitreous VEGF clearance is increased after vitrectomy[J]. Invest Ophthalmol Vis Sci, 2010, 51(4): 2135-2138. DOI: 10.1167/iovs.09-3582.
28.	Matsunaga N, Ozeki H, Hirabayashi Y, et al. Histopathologic evaluation of the internal limiting membrane surgically excised from eyes with diabetic maculopathy[J]. Retina, 2005, 25(3): 311-316. DOI: 10.1097/00006982-200504000-000.
29.	Sonoda KH, Sakamoto T, Enaida H, et al. Residual vitreous cortex after surgical posterior vitreous separation visualized by intravitreous triamcinolone cetonide[J]. Ophthalmology, 2004, 111(2): 226-230. DOI: 10.1016/j.ophtha.2003.05.034.
30.	Recchia FM, Ruby AJ, Carvalho Recchia CA. Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema[J]. Am J Ophthalmol, 2005, 139(3): 447-454. DOI: 10.1016/j.ajo.2004.09.076.
31.	Kenawy N, Wong D, Stappler T, et al. Does the presence of an epiretinal membrane alter the cleavage plane during internal limiting membrane peeling?[J]. Ophthalmology, 2010, 117(2): 320-323. DOI: 10.1016/j.ophtha.2009.07.024.
32.	Romano MR, Romano V, Vallejo-Garcia JL, et al. Macuar hypotrophy after interal limiting membrane removal for diabetic macular edema[J]. Retina, 2014, 34(6): 1182-1189. DOI: 10.1097/IAE.0000000000000076.
33.	Hu XY, Liu H, Wang LN, et al. Efficacy and safety of vitrectomy with internal limiting membrane peeling for diabetic macular edema: a meta-analysis[J]. Int J Ophthalmol, 2018, 11(11): 1848-1855. DOI: 10.18240/ijo.2018.11.18.
34.	Rinaldi M, dell'Omo R, Morescalchi F, et al. ILM peeling in nontractional diabetic macular edema: review and metanalysis[J]. Int Ophthalmol, 2018, 38(6): 2709-2714. DOI: 10.1007/s10792-017-0761-6.
35.	Kim YT, Kang SW, Kim SJ, et al. Combination of vitrectomy, IVTA, and laser photocoagulation for diabetic macular edema unresponsive to prior treatments; 3-year results[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(5): 679-684. DOI: 10.1007/s00417-011-1888-1.
36.	Chang-Lin JE, Burke JA, Peng Q, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4605-4609. DOI: 10.1167/iovs.10-6387.
37.	Boyer DS, Faber D, Gupta S, et al. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients[J]. Retina, 2011, 31(5): 915-923. DOI: 10.1097/IAE.0b013e318206d18c.
38.	Kim KT, Jang JW, Kang SW, et al. Vitrectomy combined with intraoperative dexamethasone implant for the management of refractory diabetic macular edema[J]. Korean J Ophthalmol, 2019, 33(3): 249-258. DOI: 10.3341/kjo.2018.0100.
39.	陈翀, 刘堃. 重视糖尿病黄斑水肿的个体化治疗[J]. 中华眼底病杂志, 2020, 36(2): 89-93. DOI: 10.3760/cma.j.issn.1005-1015.2020.02.001.Chen C, Liu K. Attach importance to individualized treatment of diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2020, 36(2): 89-93. DOI: 10.3760/cma.j.issn.1005-1015.2020.02.001.
40.	Yamada Y, Suzuma K, Ryu M, et al. Systemic factors influence the prognosis of diabetic macular edema after pars plana vitrectomy with internal limiting membrane peeling[J]. Curr Eye Res, 2013, 38(12): 1261-1265. DOI: 10.3109/02713683.2013.820327.
41.	Morizane Y, Kimura S, Hosokawa M, et al. Planned foveal detachment technique for the resolution of diffuse diabetic macular edema[J]. Jpn J Ophthalmol, 2015, 59(5): 279-287. DOI: 10.1007/s10384-015-0390-4.
42.	El-Baha SM, Abdel Hadi AM, Abouhussein MA. Submacular injection of ranibizumab as a new surgical treatment for refractory diabetic macular edema[J/OL]. J Ophthalmol, 2019, 21: 6274209[2019-08-21]. https://pubmed.ncbi.nlm.nih.gov/31772766/. DOI: 10.1155/2019/6274209.
43.	Michalewska Z, Stewart MW, Landers MB 3rd, et al. Vitrectomy in the management of diabetic macular edema in treatment-naïve patients[J]. Can J ophthalmol, 2018, 53(4): 402-407. DOI: 10.1016/j.jcjo.2017.10.011.

1. 中华医学会眼科学分会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
2. Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic maeular edema by the European Society of Retina Specialists(EURETINA)[J]. Ophthalmologica, 2017, 237(4): 185-222. DOI: 10.1159/000458539.
3. Bressler SB, Qin H, Beck RW, et al. Factors associated with changes in visual acuity and central subfield hickness at 1 year after treatment for diabetic macular edema with ranibizumab[J]. Arch Ophthalmol, 2012, 130(2): 1153-1161. DOI: 10.1001/archophthalmol.2012.1107.
4. Stolba U, Binder S, Gruber D, et al. Vitrectomy for persistent diffuse diabetic macular edema[J]. Am J Ophthalmol, 2005, 140(3): 295-301. DOI: 10.1016/j.ajo.2005.03.045.
5. Gandorfer A. Role of vitreous in diabetic macular edema[J]. Retina, 2012, 32(Suppl): S211-215. DOI: 10.1097/IAE.0b013e31825bc704.
6. Sebag J, Buckingham B, Charles MA, et al. Biochemical abnormalities in vitreous of humans with proliferative diabetic retinopathy[J]. Arch Ophthalmol, 1992, 110(10): 1472-1476. DOI: 10.1001/archopht.1992.01080220134035.
7. Lopes de Faria JM, Jalkh AE, Trempe CL, et al. Diabetic macular edema: risk factors and concomitants[J]. Acta Ophthalmol Scand, 1999, 77(2): 170-175. DOI: 10.1034/j.1600-0420.1999.770211.x.
8. Tachi N, Ogino N. Vitrectomy for diffuse macular edema in cases of diabetic retinopathy[J]. Am J Ophthalmol, 1996, 8(1): 258-260. DOI: 10.1016/s0002-9394(14)72018-5.
9. Lewis H, Abrams GW, Blumenkranz MS, et al. Vitrectomy for diabetic macular traction and edema associated with posterior hyaloidal traction[J]. Ophthalmology, 1992, 99(5): 753-759. DOI: 10.1016/s0161-6420(92)31901-3.
10. Jumper JM, Embabi SN, Toth CA, et al. Electron immunocytochemical analysis of posterior hyaloid associated with diabetic macular edema[J]. Retina, 2000, 20(1): 63-68. DOI: 10.1097/00006982-200001000-00012.
11. Kishi S, Shimizu K. Clinical manifestations of posterior precortical vitreous pocket in proliferative diabetic retinopathy[J]. Ophthalmology, 1993, 100(2): 225-229. DOI: 10.1016/s0161-6420(93)31666-0.
12. Spaide RF. Measurement of the posterior precortical vitreous pocket in fellow eyes with posterior vitreous detachment and macular holes[J]. Retina, 2003, 23(4): 481-485. DOI: 10.1097/00006982-200308000-00006.
13. Fine BS. Limiting membranes of the sensory retina and pigment epithelium. an electron microscopic study[J]. Arch Ophthalmol, 1961, 66: 847-860. DOI: 10.1001/archopht.1961.00960010849012.
14. Barile GR, Pachydaki SI, Tari SR, et al. The RAGE axis in early diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2005, 6(8): 2916-2924. DOI: 10.1167/iovs.04-1409.
15. Abari E, Kociok N, Hartmann U, et al. Alterations in basement membrane immunoreactivity of the diabetic retina in three diabetic mouse models[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(3): 763-775. DOI: 10.1007/s00417-012-2237-8.
16. Tamura K, Yokoyama T, Ebihara N, et al. Histopathologic analysis of the internal limiting membrane surgically peeled from eyes with diffuse diabetic macular edema[J]. Jpn J Ophthalmol, 2012, 56(3): 280-287. DOI: 10.1007/s10384-012-0130-y.
17. Funatsu H, Yamashita H, Noma H, et al. Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema[J]. Am J Ophthalmol, 2002, 133(1): 70-74. DOI: 10.1016/s0002-9394(01)01269-7.
18. Funatsu H, Noma H, Mimura T, et al. Association of vitreous inflammatory factors with diabetic macular edema[J]. Ophthalmology, 2009, 16(1): 73-79. DOI: 10.1016/j.ophtha.2008.09.037.
19. Haller JA, Qin H, Apte RS, et al. Vitrectomy outcomes in eyes with diabetic macular edema and itreomacular traction[J]. Ophthalmology, 2010, 117(6): 1087-1093. DOI: 10.1016/j.ophtha.2009.10.040.
20. Pessoa B, Dias DA, Baptista P, et al. Vitrectomy outcomes in eyes with tractional diabetic macular edema[J]. Ophthalmic Res, 2019, 61(2): 94-99. DOI: 10.1159/000489459.
21. Kumagai K, Furukawa M, Ogino N, et al. Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema[J]. Retina, 2009, 29(4): 464-472. DOI: 10.1097/IAE.0b013e31819c632f.
22. Bonnin S, Sandali O, Bonnel S, et al. Vitrectomy with internal limiting membrane peeling for tractional and nontractional diabetic macular edema: long-term results of a comparative study[J]. Retina, 2015, 35(5): 921-928. DOI: 10.1097/IAE.0000000000000433.
23. Funatsu H, Yamashita H, Nakamura S, et al. Vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor are related to diabetic macular edema[J]. Ophthalmology, 2006, 113(2): 294-301. DOI: 10.1016/j.ophtha.2005.10.030.
24. Stefánsson E. Ocular oxygenation and the treatment of diabetic retinopathy[J]. Surv Ophthalmol, 2006, 51(4): 364-380. DOI: 10.1016/j.survophthal.2006.04.005.
25. Simpson AR, Dowell NG, Jackson TL, et al. Measuring the effect of pars plana vitrectomy on vitreous oxygenation using magnetic resonance imaging[J]. Invest Ophthalmol Vis Sci, 2013, 54(3): 2028-2034. DOI: 10.1167/iovs.12-11258.
26. Stefánsson E. Physiology of vitreous surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2009, 247(2): 147-163. DOI: 10.1007/s00417-008-0980-7.
27. Lee SS, Ghosn C, Yu Z, et al. Vitreous VEGF clearance is increased after vitrectomy[J]. Invest Ophthalmol Vis Sci, 2010, 51(4): 2135-2138. DOI: 10.1167/iovs.09-3582.
28. Matsunaga N, Ozeki H, Hirabayashi Y, et al. Histopathologic evaluation of the internal limiting membrane surgically excised from eyes with diabetic maculopathy[J]. Retina, 2005, 25(3): 311-316. DOI: 10.1097/00006982-200504000-000.
29. Sonoda KH, Sakamoto T, Enaida H, et al. Residual vitreous cortex after surgical posterior vitreous separation visualized by intravitreous triamcinolone cetonide[J]. Ophthalmology, 2004, 111(2): 226-230. DOI: 10.1016/j.ophtha.2003.05.034.
30. Recchia FM, Ruby AJ, Carvalho Recchia CA. Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema[J]. Am J Ophthalmol, 2005, 139(3): 447-454. DOI: 10.1016/j.ajo.2004.09.076.
31. Kenawy N, Wong D, Stappler T, et al. Does the presence of an epiretinal membrane alter the cleavage plane during internal limiting membrane peeling?[J]. Ophthalmology, 2010, 117(2): 320-323. DOI: 10.1016/j.ophtha.2009.07.024.
32. Romano MR, Romano V, Vallejo-Garcia JL, et al. Macuar hypotrophy after interal limiting membrane removal for diabetic macular edema[J]. Retina, 2014, 34(6): 1182-1189. DOI: 10.1097/IAE.0000000000000076.
33. Hu XY, Liu H, Wang LN, et al. Efficacy and safety of vitrectomy with internal limiting membrane peeling for diabetic macular edema: a meta-analysis[J]. Int J Ophthalmol, 2018, 11(11): 1848-1855. DOI: 10.18240/ijo.2018.11.18.
34. Rinaldi M, dell'Omo R, Morescalchi F, et al. ILM peeling in nontractional diabetic macular edema: review and metanalysis[J]. Int Ophthalmol, 2018, 38(6): 2709-2714. DOI: 10.1007/s10792-017-0761-6.
35. Kim YT, Kang SW, Kim SJ, et al. Combination of vitrectomy, IVTA, and laser photocoagulation for diabetic macular edema unresponsive to prior treatments; 3-year results[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(5): 679-684. DOI: 10.1007/s00417-011-1888-1.
36. Chang-Lin JE, Burke JA, Peng Q, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4605-4609. DOI: 10.1167/iovs.10-6387.
37. Boyer DS, Faber D, Gupta S, et al. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients[J]. Retina, 2011, 31(5): 915-923. DOI: 10.1097/IAE.0b013e318206d18c.
38. Kim KT, Jang JW, Kang SW, et al. Vitrectomy combined with intraoperative dexamethasone implant for the management of refractory diabetic macular edema[J]. Korean J Ophthalmol, 2019, 33(3): 249-258. DOI: 10.3341/kjo.2018.0100.
39. 陈翀, 刘堃. 重视糖尿病黄斑水肿的个体化治疗[J]. 中华眼底病杂志, 2020, 36(2): 89-93. DOI: 10.3760/cma.j.issn.1005-1015.2020.02.001.Chen C, Liu K. Attach importance to individualized treatment of diabetic macular edema[J]. Chin J Ocul Fundus Dis, 2020, 36(2): 89-93. DOI: 10.3760/cma.j.issn.1005-1015.2020.02.001.
40. Yamada Y, Suzuma K, Ryu M, et al. Systemic factors influence the prognosis of diabetic macular edema after pars plana vitrectomy with internal limiting membrane peeling[J]. Curr Eye Res, 2013, 38(12): 1261-1265. DOI: 10.3109/02713683.2013.820327.
41. Morizane Y, Kimura S, Hosokawa M, et al. Planned foveal detachment technique for the resolution of diffuse diabetic macular edema[J]. Jpn J Ophthalmol, 2015, 59(5): 279-287. DOI: 10.1007/s10384-015-0390-4.
42. El-Baha SM, Abdel Hadi AM, Abouhussein MA. Submacular injection of ranibizumab as a new surgical treatment for refractory diabetic macular edema[J/OL]. J Ophthalmol, 2019, 21: 6274209[2019-08-21]. https://pubmed.ncbi.nlm.nih.gov/31772766/. DOI: 10.1155/2019/6274209.
43. Michalewska Z, Stewart MW, Landers MB 3rd, et al. Vitrectomy in the management of diabetic macular edema in treatment-naïve patients[J]. Can J ophthalmol, 2018, 53(4): 402-407. DOI: 10.1016/j.jcjo.2017.10.011.

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