Objective:

To evaluate the effectiveness of early pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in treatment-naïve diabetic macular edema (DME) patients who may not adhere to anti-VEGF treatment.

Key Findings:

• Significant improvements in visual acuity (mean best-corrected visual acuity improved from 0.66 logMAR to 0.53 logMAR) and retinal thickness (central subfield thickness decreased from 593 microns to 230 microns).
• 43% of patients gained at least five ETDRS letters, and 31.7% gained 10 or more letters.
• Earlier surgery correlated with better visual outcomes, with a 1.8% decrease in chances of gaining five or more letters for each day of delayed intervention.
• Identified OCT biomarkers associated with favorable outcomes included subretinal fluid, preserved IS/OS integrity, and relatively recent-onset DME.

Interpretation:

PPV with ILM peeling may provide durable visual and anatomic benefits for selected DME patients who are unlikely to adhere to anti-VEGF treatment, but it should not replace anti-VEGF therapy as the first-line option.

Limitations:

• The study was limited to a specific patient population and may not be generalizable to all DME patients.
• Follow-up duration was limited to 24 months, which may not capture long-term outcomes.

Conclusion:

While PPV with ILM peeling shows promise for certain DME patients, anti-VEGF therapy remains the standard first-line treatment.