The rising prevalence of diabetes mellitus increases the need for treatment of diabetic maculopathy (DM). Evaluation of surgical outcomes in DM, including postoperative microstructural changes in the retina and its vascular plexuses, remains a relevant challenge.

PURPOSE

This article assesses changes in angiographic parameters of the retinal capillary plexuses after surgical treatment of DM using various methods of internal limiting membrane (ILM) peeling.

MATERIAL AND METHODS

Vitreoretinal surgery, including vitrectomy with membrane peeling, was performed in comparable groups of patients with proliferative diabetic retinopathy and DM. The surgical methods differed in the approach to retinal ILM peeling: in group 1 the ILM was completely removed; group 2 underwent dosed fovea-sparing peeling (DFSP) of the ILM; in group 3 the ILM was left intact. Postoperative outcomes were compared between groups using optical coherence tomography angiography (OCT-A).

RESULTS

Intergroup comparisons across all time points and parameters did not reveal statistically significant differences. The analysis showed no significant changes in angiographic parameters in groups 1 and 3. In group 2 significant changes were observed in the parameters of deep capillary plexus: increased vessel density, vessel skeleton density and vessel perimeter index, as well as reduced foveal avascular zone (FAZ) area. Correlation analysis revealed that high FAZ area values in the deep capillary plexus were predictors of the development of retinal atrophy in the long-term.

CONCLUSION

The obtained results demonstrate the dynamics of changes following DFSP of the ILM in both the neuronal structures of the retina and its capillary plexuses, with these changes tending toward normalization of retinal structure.