Deferred cyst deroofing phemonenon after membrane peeling for diabetic macular edema

Relevance In some cases, for example, with traction genesis or in combination with epimacular fibrosis, diabetic macular edema (DME) requires vitreoretinal surgical treatment [1]. In these cases, peeling of the inner limiting membrane of the retina (ILM) is a frequently used intraoperative manipulation [2]. Currently, the feasibility of its implementation is the subject of active study, since a number of complications associated with its implementation have been described [2-4]. One example of such complications is the unintentional opening of intraretinal cysts - cyst-deroofing phenomenon (CD-ph) [4]. Objective To clarify the mechanism of development and evaluate the incidence of delayed CD-ph in the postoperative period. Material and methods The study assessed the incidence of this complication after surgical treatment of DME in comparable groups of patients (20 cases, 20 eyes), differing in the type of impact on the ILM. In the main group, the ILM was removed with the fovea zone, para- and perimacularly, in the comparison group, center-sparing peeling was performed without involving the fovea and macula, in the control group, the ILM was preserved within the interarcade space. Results In the comparison and control groups, the development of CD-f was not observed in any case. In the main group, at a follow-up period of 3 months, delayed CD-f was noted in 3 patients. This observation differs from the typical picture of cyst rupture formation intraoperatively or in the first or second day after vitrectomy. According to optical coherence tomography, the patients retained a central cyst in the fovea at 1 week and 1 month after surgery, then neurodegenerative changes developed in the cyst layers corresponding to the inner layers of the retina in the central fovea zone. Conclusion Thus, the development of delayed CD-f can be regarded as a variant of postoperative neurodegenerative complication associated with ILM peeling. A possible measure for preventing the development of delayed CD-f can be gentle methods of ILM peeling, including peeling with intraoperative tomographic control [5]. Keywords: vitreoretinal surgery; diabetic macular edema; membrane peeling; internal limiting membrane; optical coherence tomography