The change of diabetic macular edema post vitrectomy in patients with proliferative diabetic retinopathy

The change of diabetic macular edema post vitrectomy in patients with proliferative diabetic retinopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The change of diabetic macular edema post vitrectomy in patients with proliferative diabetic retinopathy Han tao Zhou, Jing hao Mei, Ke Lin, Chu ying Deng, Wei Lin, Zu shun Lin, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2821095/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To investigate the change of diabetic macular edema (DME) post vitrectomy and its risk factors. Methods Retrospective study design. This study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy with gradable optical coherence tomography imaging from January 2018 to March 2022. The incidence of post vitrectomy DME (PV-DME) was defined as patients with a central retinal thickness (CRT) > 300 µm by optical coherence tomography among patients without preoperative DME. Results The cumulative incidence of PV-DME at 3 months was 40.1% (89/222), with its majority subtype of single diffused retinal thickening (66.2%) followed by single cystoid macular edema (27.0%). Multivariate Cox regression analysis indicated that a thicker preoperative CRT (HR = 1.01, 95% CI 1.00–1.02) and intraoperative internal limiting membrane peeling (HR = 3.18, 95% CI 1.85–5.47) were associated with the presence of PV-DME, while intraoperative intravitreal injection of triamcinolone acetonide (HR = 0.28, 95% CI 0.13–0.57) was protective against PV-DME. In eyes with preoperative DME (n = 143), the CRT decreased gradually from 468.3 ± 177.7 µm preoperatively to 409.5 ± 151.0 µm (P = 0.027), 377.4 ± 141.9 µm (P < 0.001), and 368.0 ± 157.6 µm (P < 0.001) at 7 days, 1 month, and 3 months postoperatively, respectively. Multivariate linear regression analysis indicated that only a thicker preoperative CRT (β = 0.77, 95% CI 0.63–0.92) was associated with a decreasing postoperative CRT. Conclusion PV-DME is a very common postoperative complication in patients with proliferative diabetic retinopathy. Triamcinolone acetonide could prevent its formation. Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling. diabetic macular edema proliferative diabetic retinopathy vitrectomy Figures Figure 1 Figure 2 INTRODUCTION Diabetic retinopathy (DR) is a major and specific microvascular complication of diabetic mellitus (DM), which remains a leading cause of vision loss and preventable blindness in working-aged adults. 1 The most common cause of vision loss in patients with DR is proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), with a high prevalence of 4.3% 2 and 15.4% 3 in a Chinese cohort, respectively. Optimal control of blood glucose, blood pressure, and possibly blood lipids remain the foundation for the reduction of the risk of retinopathy development and progression. Current treatment strategies for DR aim at managing microvascular complications, including intravitreal pharmacologic agents and laser photocoagulation. 4 However, when DR has progressed to PDR, pars plana vitrectomy (PPV) is needed to offer relief from retinal traction, clearing of media opacities, and stabilization of the proliferation process. 4 , 5 Although advances in modern PPV for PDR have improved visual outcomes, post vitrectomy DME (PV-DME) occurs commonly. Macular edema (ME) consists of intraretinal or subretinal fluid accumulation in the macular region, a common postoperative complication that can cause severe impairment of central vision. 6 A better understanding of PV-DME, particularly its incidence and predisposing risk factors, is necessary to estimate the clinical burden and develop a preventative strategy for this complication. However, there is little information in the current literature regarding PV-DME. Yoshida et al showed that the elevated monocyte chemoattractant protein-1 (MCP-1) and interleukin (IL)-6 levels after PPV may indicate prolonged inflammation, which can cause postoperative DME. 7 A recent study reported that insulin treatment may reduce the risk of postoperative DME. 8 However, PV-DME incidence and onset time were not accessed among these studies. Moreover, because of the preoperative media opacification, preoperative DME was unable to be evaluated. With respect to the above, the purpose of this study was to investigate the incidence of newly developed PV-DME and the factors affecting its development. We also evaluated the effect of PPV on patients with preoperative DME. METHODS This is a retrospective study on patients with PDR who underwent PPV from January 2018 to March 2022 at a tertiary medical center. The research protocol complies with the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of the Eye Hospital of Wenzhou Medical University. The informed consent was waived. The patients’ clinical information was obtained from archived electronic medical records. The inclusion criteria were: 1) patients who underwent PPV for PDR from January 2018 to March 2022; 2) a 3-month or longer follow-up after surgery; 3) gradable optical coherence tomography (OCT) imaging before surgery. The exclusion criteria were: 1) silicone oil tamponade; 2) a history of PPV; 3) any intraocular surgery within 3 months prior to and after this PPV; 4) other ocular conditions that may be responsible for the ME, such as uveitis, retinal vein occlusion, and ocular trauma; 5) patients with a serious postoperative complication, such as neovascular glaucoma and retinal artery occlusion; 6) a history of penetrating ocular trauma. The 23- or 25-gauge PPVs were performed under retrobulbar (50% mixture of 2% lidocaine and 0.75% bupivacaine) or general anesthesia using two different vitrectomy machines (Stellaris PC, Bausch & Lomb, Bridgewater Township, NJ; Constellation Vision System, Alcon Laboratories). Additional internal limiting membrane (ILM) peeling, epiretinal membrane (ERM) peeling, or other procedures (PRP, gas injection, combined cataract surgery, intraocular lens implantation, etc.) were performed according to the surgeon’s experience. We used spectral-domain OCT (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany) with a 30° scanning angle (9×9 mm) at the central macula for image acquisition and the analysis protocol. Central retinal thickness (CRT) was measured at the central 1-mm region of the standard Early Treatment Diabetic Retinopathy Study subfield. The diagnosis of PV-DME was confirmed if the OCT imaging of the macular showed typical findings of retinal thickening (CRT ≥ 300 µm) 9 , 10 among patients without preoperative DME. There were three OCT patterns of DME, which was diffused retinal thickening (DRT) as a sponge-like retinal swelling of the macula with reduced intraretinal reflectivity, cystoid macular edema (CME) as intraretinal cystoid spaces of low reflectivity and highly reflective septa separating cystoid-like cavities in the macular area, and serous retinal detachment (SRD) as a shallow elevation of the retina and an optically clear space between the neurosensory retina and retinal pigment epithelium. 11 The OCT images of mixed DME patterns, defined as the mixture of two of these OCT patterns, were also included in our study. The presence of ERM, tractional retinal detachment, and posterior hyaloidal traction were also determined. PDR was classified into three stages: stage 1: neovascularization of the retina, vitreous hemorrhage or preretinal hemorrhage; stage 2: neovascularization of the retina, and fibrovascular membranes; stage 3: stage 2 plus tractional retinal detachment. Statistical analysis Statistical analysis was performed using SPSS (IBM, Armonk, NY, version 25.0). A Kaplan–Meier survival curve was constructed to show the cumulative incidence of newly developed postoperative DME. Multiple comparisons were performed with repeated measures analysis of variance, followed by Bonferroni multiple comparison test to compare the CRT between pre-operation, 7 days, 1 month, and 3 months after surgery. Univariate analysis of categorical variables was performed by the chi-square test or Fisher exact test. Independent t-test was used to compare the mean values of normally distributed variables. All variables with a P-value < 0.1 in univariate Cox regression analysis or variables considered clinically meaningful were entered into multivariate Cox regression analysis to determine the risk factors for PV-DME. All variables with a P-value < 0.1 in univariate liner regression analysis or variables considered clinically meaningful were entered into multivariate liner regression analysis to determine the risk factors for the change of CRT from pre-operation to 3 months postoperatively. Statistical significance was determined using a threshold of P < 0.05. RESULTS A total of 365 eyes from 330 patients (male 196, 59.3%) who underwent PPV for PDR were enrolled in this study. The mean age of the patients was 57.3 ± 10.3 years. All patients were divided into two groups according to the presence of DME before surgery. Group A (n = 222) were the patients without preoperative DME; Group B (n = 143) were the patients with preoperative DME. In Group A, patients with postoperative DME were younger (P = 0.02), had a greater preoperative CRT (P < 0.001), higher proportion of males (P = 0.01), higher proportion of preoperative intravitreal injection of anti-VEGF (anti-vascular endothelial growth factor) (P = 0.026), higher proportion of intraoperative ILM peeling (P < 0.001), and higher proportion of intraoperative intravitreal injection (P = 0.004). By contrast, no statistical significance was found in Group B (Table 1 ). Table 1 Demographic and clinical characteristics of patients with and without preoperative diabetic macular edema Group A: Preoperative ME (-) (n = 222) Group B: Preoperative ME (+) (n = 143) Postoperative ME (-) (n = 133) Postoperative ME (+) (n = 89) P-value Postoperative ME (-) (n = 31) Postoperative ME (+) (n = 112) P-value Age (years) 57.1 ± 9.8 54.00 ± 9.1 0.02 61.6 ± 8.6 59.9 ± 11.1 0.45 Male 66 (49.6) 59 (66.3) 0.01 19 (61.3) 65 (58.0) 0.75 Stage of PDR Stage 1 Stage 2 Stage 3 49 (36.8) 50 (37.6) 34 (25.6) 30 (33.7) 38 (42.7) 21 (23.6) 0.75 11 (35.5) 14 (45.2) 6 (19.4) 37 (33.0) 51 (45.5) 24 (21.4) 0.95 Duration of DM < 10 years 10 ~ 20 years ≥ 20 years 32 (24.1) 62 (46.6) 39 (29.3) 31 (34.8) 31 (46.1) 17 (19.1) 0.11 7 (22.6) 18 (58.1) 6 (19.4) 35 (31.3) 52 (46.4) 25 (22.3) 0.50 Insulin treatment No Yes 68 (51.1) 65 (48.9) 55 (61.8) 34 (38.2) 0.12 18 (58.1) 13 (41.9) 69 (61.6) 43 (38.4) 0.72 FPG (mmol/L) 8.3 ± 3.2 8.1 ± 2.6 0.54 8.0 ± 1.9 8.8 ± 3.2 0.21 HbA1c (%) 8.0 ± 1.4 8.1 ± 1.4 0.69 7.9 ± 1.2 8.0 ± 1.6 0.80 Preoperative CRT (µm) 201.7 ± 43.6 228.0 ± 36.5 < 0.001 436.3 ± 171.3 475.7 ± 179.1 0.30 Pattern of preoperative ME CME DRT CME + SRD DRT + SRD / / / 16 (25.4) 13 (21.3) 2 (12.5) 0 (0) 47 (74.6) 48 (78.7) 14 (87.5) 3 (100) 0.41 Preoperative ERM 15 (11.3) 11 (12.4) 0.81 18 (58.1) 52 (46.4) 0.25 Preoperative Intravitreal injection of anti-VEGF 53 (39.8) 49 (55.1) 0.03 10 (32.3) 49 (53.7) 0.25 Intraoperative ERM peeling 10 (7.5) 9 (10.1) 0.50 18 (58.1) 46 (41.1) 0.09 Intraoperative ILM peeling 61 (45.9) 69 (77.5) < 0.001 24 (77.4) 92 (82.1) 0.55 Intraoperative Combined cataract surgery 112 (84.2) 78 (87.6) 0.48 25 (80.6) 97 (86.6) 0.59 Intraoperative PRP 127 (95.5) 88 (98.9) 0.16 28 (90.3) 104 (92.9) 0.93 Intraoperative Intravitreal injection No Anti-VEGF TA 77 (57.9) 7 (5.3) 49 (36.8) 74 (83.1) 6 (6.7) 9 (10.1) 0.004 19 (61.3) 1 (3.2) 11 (35.5) 71 (63.4) 11 (9.8) 30 (26.8) 0.34 Postoperative pattern of ME CME DRT CME + SRD DRT + SRD 24 (27) 59 (66.3) 3 (3.4) 3 (3.4) 35 (31.3) 63 (56.3) 11 (9.8) 3 (2.7) Continual variables are presented as mean ± standard deviation; classified variables are presented as number and percentage. ME: macular edema; PDR: proliferative diabetic retinopathy; DM: diabetes mellitus; FPG: fasting plasma glucose; CRT: central retinal thickness; CME: cystoid macular edema; DRT: diffused retinal thickening; SRD: serous retinal detachment; ERM: epiretinal membrane; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide. In Group A, the cumulative incidence of PV-DME within a 3-month follow-up period are presented in Fig. 1. The cumulative incidence at 3 months was 40.1% (89/222). Of the 89 eyes with postoperative DME, 24 eyes (27.0%) displayed CME alone, 59 eyes (66.2%) showed DRT alone, 3 (3.4%) displayed CME and SRD, and 3 (3.4%) showed DRT and SRD. In Group B, before PPV, 63 eyes (44.0%) displayed CME alone, 61 eyes (42.7%) showed DRT alone, 16 (11.2%) displayed CME and SRD, and 3 (2.1%) showed DRT and SRD preoperatively. After PPV, 112 eyes (78.3%) retained ME within the 3-month follow-up period. Of these 112 eyes, the numbers of CME alone, DRT alone, CME and SRD, and DRT and SRD were 35 (31.3%), 63 (56.3%), 11 (9.8%), and 3 (2.7%), respectively. Table 2 presents the incidence of PV-DME in Group A. Male patients (P = 0.01) and patients with a thicker preoperative CRT (P < 0.001), with preoperative intravitreal injection of anti-VEGF (P = 0.03), with intraoperative ILM peeling (P < 0.001), or without intraoperative intravitreal injection of triamcinolone acetonide (TA) (P < 0.001) had a higher incidence of PV-DME. Table 2 Incidence of post vitrectomy diabetic macular edema in patients without preoperative diabetic macular edema Parameters Incidence of PV-DME (n, %) P-value Age < 55 years ≥ 55 years 95 (46.3) 127 (35.4) 0.10 Gender Male Female 125 (47.2) 97 (30.9) 0.01 Stage of PDR Stage 1 Stage 2 Stage 3 79 (38.0) 88 (43.2) 55 (38.2) 0.75 Duration of DM 6.1 mmol/L 51 (41.2) 165 (38.8) 0.76 HbA1c < 6.5% ≥ 6.5% 20 (30.0) 192 (39.1) 0.42 Preoperative CRT < 212.50 µm ≥ 212.50 µm 110 (26.4) 112 (53.6) < 0.001 Preoperative ERM No Yes 196 (39.8) 26 (42.3) 0.80 Preoperative Intravitreal injection of anti-VEGF No Yes 120 (33.3) 102 (48.0) 0.03 Intraoperative ERM peeling No Yes 203 (39.4) 19(47.4) 0.50 Intraoperative ILM peeling No Yes 92 (21.7) 130 (53.1) < 0.001 Intraoperative Combined cataract surgery No Yes 32 (34.3) 190 (41.1) 0.48 Intraoperative PRP No Yes 7 (14.3) 215 (40.9) 0.16 Intraoperative Intravitreal injection No Anti-VEGF TA 151 (49.0) 13 (46.2) 58 (15.5) < 0.001 PV-DME: post vitrectomy diabetic macular edema; PDR: proliferative diabetic retinopathy; DM: diabetes mellitus; FPG: fasting plasma glucose; CRT: central retinal thickness; ERM: epiretinal membrane; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide. Table 3 presents the changes in CRT in Group B. Patients with a thicker preoperative CRT displayed a significant association with the greater changes in CRT (P < 0.001). Table 3 Changes in central retinal thickness in patients with preoperative diabetic macular edema Parameters Changes of CRT (mean ± SD, µm) P- value Age < 55 years ≥ 55 years 114.5 ± 192.3 93.7 ± 203.1 0.58 Gender Male Female 76.3 ± 196.2 132.6 ± 201.7 0.10 Stage of PDR Stage 1 Stage 2 Stage 3 73.8 ± 173.0 116.4 ± 199.0 104.0 ± 240.6 0.53 Duration of DM 6.1 mmol/L 53.4 ± 148.4 108.4 ± 207.4 0.35 HbA1c < 6.5% ≥ 6.5% 175.5 ± 195.4 91.6 ± 199.3 0.09 Preoperative CRT < 450 µm ≥ 450 µm 25.1 ± 125.1 222.3 ± 237.1 < 0.001 Preoperative ERM No Yes 88.0 ± 233.0 111.6 ± 159.1 0.48 Preoperative Intravitreal injection of anti-VEGF No Yes 122.5 ± 216.2 66.9 ± 170.1 0.10 Intraoperative ERM peeling No Yes 82.7 ± 227.3 120.4 ± 158.5 0.26 Intraoperative ILM peeling No Yes 87.6 ± 263.5 102.3 ± 183.0 0.72 Intraoperative Combined cataract surgery No Yes 100.4 ± 142.7 99.4 ± 208.4 0.98 Intraoperative PRP No Yes 91.18 ± 87.3 100.2 ± 206.5 0.89 Intraoperative Intravitreal injection No Anti-VEGF TA 81.93 ± 187.5 170.2 ± 176.7 117.5 ± 228.6 0.28 SD: standard deviation; PDR: proliferative diabetic retinopathy; DM: diabetes mellitus; FPG: fasting plasma glucose; CRT: central retinal thickness; ERM: epiretinal membrane; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide. Figure 2 presents the changes of CRT over time in Group B during the 3-month follow-up period. The CRT decreased gradually from 468.3 ± 177.7 µm preoperatively to 409.5 ± 151.0 µm (P = 0.03), 377.4 ± 141.9 µm (P < 0.001), and 368.0 ± 157.6 µm (P < 0.001) at 7 days, 1 month, and 3 months postoperatively, respectively. Multivariate Cox regression analysis was performed to determine the risk factors for PV-DME, and found that a thicker preoperative CRT (HR = 1.01, 95% CI 1.00 to 1.02), intraoperative ILM peeling (HR = 3.19, 95% CI 1.85 to 5.49), and intraoperative intravitreal TA injection (HR = 0.28, 95% CI 0.13 to 0.57) were associated with PV-DME (Table 4 ). Table 4 Multivariate Cox regression analysis of risk factors for post vitrectomy diabetic macular edema in patients without preoperative diabetic macular edema Category Multi-factor analysis HR (95%CI) P-value Age 0.98 (0.96 to 1.00) 0.11 Gender 0.79 (0.50 to 1.26) 0.32 Duration of DM 0.82 (0.60 to 1.12) 0.21 Preoperative CRT 1.01 (1.00 to 1.02) < 0.001 Preoperative Intravitreal injection of anti-VEGF 0.85 (0.52 to 1.38) 0.50 Intraoperative ILM peeling 3.19 (1.85 to 5.49) < 0.001 Intraoperative intravitreal injection Intraoperative intravitreal injection (anti-VEGF) Intraoperative intravitreal injection (TA) 0.92 (0.38 to 2.21) 0.28 (0.13 to 0.57) 0.84 < 0.001 DM: diabetes mellitus; CRT: central retinal thickness; Anti-VEGF: anti-vascular endothelial growth factor; ILM: internal limiting membrane; TA: triamcinolone acetonide. To determine the risk factors influencing the amount of postoperative CRT change in Group B, multivariate linear regression analysis was performed. Only a thicker preoperative CRT ( β = 0.77, 95% CI 0.63 to 0.92) was found to be associated with a decreasing postoperative CRT (Table 5 ). Table 5 Multivariate linear regression analysis of risk factors influencing the amount of central retinal thickness change from pre-operation to 3 months postoperatively in patients with preoperative diabetic macular edema Category Multi-factor analysis β (95%CI) P-value Age -1.30 (-3.87 to 1.26) 0.32 Gender 34.76 (-16.87 to 86.39) 0.19 Stage of PDR -12.06 (-49.16 to 25.03) 0.58 HbA1c 4.08 (-14.41 to 22.58) 0.59 FPG -4.41 (-13.77 to 4.95) 0.40 Preoperative CRT 0.77 (0.63 to 0.92) < 0.001 Preoperative intravitreal injection of anti-VEGF -13.67 (-73.38 to 46.04) 0.65 Intraoperative ILM peeling 39.02 (-28.63 to 106.68) 0.26 Intraoperative combined cataract surgery -14.53 (-85.77 to 56.71) 0.69 Intraoperative PRP -16.59 (-120.94 to 87.76) 0.75 Intraoperative Intravitreal injection Intraoperative Intravitreal injection (anti-VEGF) Intraoperative Intravitreal injection (TA) -24.06 (-127.86 to 79.75) -24.36 (-85.65 to 36.93) 0.65 0.43 PDR: proliferative diabetic retinopathy; FPG: fasting plasma glucose; CRT: central retinal thickness; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide. DISCUSSION When using the criterion of a CRT ≥ 300 µm, the present study found a very high incidence of PV-DME of 40.1%, with the majority subtype being DRT alone (66.2%), followed by CME alone (27.0%). This high incidence indicated that 40% of PDR patients may need further treatment, such as intravitreal drug injection, to regain visual function even after PPV. Although a direct comparison was difficult, the current reported incidence was higher than in other studies. A retrospective cohort study showed that of the 124 eyes that underwent PPV for PDR, 10 eyes (8.06%) presented postoperative ME. 8 Sun et al conducted a study focused on the effect of preoperative injection on vitreous inflammatory cytokines and chemokines and showed that 20 eyes (33.90%) presented ME. 12 In contrast with previous studies, we excluded patients with an unreadable preoperative OCT image and postoperative silicone oil tamponade to focus on the incidence of PV-DME. Patients frequently required the removal of the silicone oil within the 3-month follow-up, and the silicone oil frequently led to decreased macular thickness and microstructural changes. 13 , 14 Moreover, the definition of ME was different among studies. For example, Sun et al determined the presence of ME only by the macular structure (such as DRT, SRD, and CME), but not CRT measurement. In the present study, the preoperative CRT and intraoperative ILM peeling were independent risk factors for newly developed PV-DME, while intraoperative TA injection prevented PV-DME. Doncel-Fernández et al reported that patients without known risk factors for developing CME and major surgical complication presented 9.08 times more probability to develop pseudophakic ME when with a preoperative central macular thickness > 260.5 µm. 15 In the present study, a thicker preoperative CRT was also found to be associated with PV-DME. Whether ILM peeling improves anatomical and functional outcomes has been extensively studied. It has been reported that additional removal of the ILM at the time of PPV may be helpful by removing all tractional forces, inhibiting the reproliferation of fibrous astrocytes, 16 and preventing postoperative ERM formation. 17 Additionally, the mean thickness of the ILM was significantly higher in diabetic patients, which may disturb the outflow of fluids accumulating into the retina and limit the diffusion of oxygen from the vitreous. 18 , 19 ILM removal improves exchanges with the oxygen-rich vitreous and promotes the discharge of liquid from the retina. A recent randomized clinical trial showed that the patients who underwent ILM peeling had a better best-corrected visual acuity and a lower incidence of ERM at 6 months than patients without ILM peeling. 20 There was also a trend towards lower central macular thickness on OCT and a lower incidence of DME treatment postoperatively. 20 Hu et al indicated that compared with vitrectomy alone, vitrectomy with ILM peeling had higher rate of CRT reduction in patients with DME. 21 However, the result of our study showed that the patients who underwent ILM peeling during PPV were more likely to present PV-DME. Given the close proximity of the ILM to the inner retina and its interdigitation with Müller cell footplates, ILM peeling would unavoidably cause damage to Müller cells. 22 Müller cells release factors that induce tight junction formation in retinal vessels. Abnormalities in Müller cells caused by ILM peeling probably affect this barrier property in the retinal vessels. 23 In addition, the role of Müller cells in controlling the movement of water and ions allows them to buffer intraretinal increases of potassium ions. Ischemia and inflammation can alter the potassium channels of Müller cells and cause them to accumulate intracellular fluid. 24 Moreover, we considered that during the procedure of ILM peeling, additional traction was applied to the retina, causing PV-DME. Chromophore toxicity, inflammation, and ganglion cell damage caused by ILM peeling, and the vulnerable vascular bed, lower integrity of the endothelium, and the loss of pericytes of patients with diabetes also contribute to PV-DME development. The current first-line treatment for DME is the intravitreal injection of anti-VEGF agent, because of its apparent effect in reducing the VEGF level, and a certain effect on the decrease in the levels of downstream inflammatory cytokines. 25 , 26 However, unexpectedly, neither preoperative nor intraoperative intravitreal anti-VEGF injection was found to prevent PV-DME in the present study. It has been reported that after preoperative intravitreal anti-VEGF injection, the VEGF level dramatically decreased, whereas the influence on the vitreous inflammatory cytokines and chemokines in PDR was limited. 12 Moreover, the decreased half-lives and increased clearance of anti-VEGF drugs in vitrectomized eyes probably also contribute. 27 Despite the preoperative intravitreal injection of anti-VEGF agent, a series of cytokines, including IL-1β, TNF-α, CXCL9, G-CSF, MCP-1, and RANTES, remained at a high level and may lead to PV-DME. 12 Yoshida et al reported that elevated MCP-1 and IL-6 levels may indicate prolonged inflammation even after successful vitrectomy, which was significantly associated with PV-DME. 7 Rather than with an anti-VEGF agent, we found an intraoperative intravitreal TA injection effectively prevented PV-DME development in this study. Takamura et al reported that intravitreal TA injection at the end of vitrectomy may inhibit postoperative inflammation and ME, which was consistent with our study. 28 Intraoperative intravitreal TA injection can effectively inhibit inflammatory cytokine production, leukostasis, and the phosphorylation of cell-junction proteins. 23 For patients with preoperative DME, 78.3% of them retained DME during the 3 months after PPV in the present study. Fortunately, the mean CRT displayed a stable trend for reduction after PPV. A greater reduction of CRT in these patients was associated with a thicker preoperative CRT, which may be due to a greater potential for CRT reduction in these patients after surgery. However, intraoperative ILM peeling and intravitreal anti-VEGF or TA injection were not found to be associated with CRT reduction. Patients with DME frequently display retinal structural abnormalities, including ellipsoid zone disruption, external limiting membrane disruption, and blood-retinal barrier breakdown, compared with patients without DME. 26 , 29 , 30 Therefore, ILM peeling appears insignificant for exacerbating the macular microstructure. Patients with preoperative DME frequently require a long time and multiple anti-VEGF treatments. Therefore, a single operative injection may not be sufficient. Our study has some strengths. First, we reported the incidence of PV-DME and DME progression after PPV in a large sample size of PDR patients. Second, preoperative and postoperative macular morphology and CRT were precisely evaluated by OCT. This study also has several limitations. First, due to the retrospective design, there were considerable discrepancies in surgical methods and the follow-up time. Second, the incidence of PV-DME may be overestimated. Patients excluded from this study tended to have poor follow-up. These patients probably had a good visual outcome and less severe DME. CONCLUSION PV-DME is a very common postoperative complication in patients with PDR. TA could prevent its formation. Particular attention should be paid to patients with a thicker preoperative CRT and ILM peeling. Declarations Financial Support This study was supported by the Zhejiang Provincial High-level health talents Training Project (CZ-RC2022010) and Wenzhou Basic Medical and Health Technology Project (Y20220779). Declaration of interest The authors declare no conflicts of interest. This manuscript has not been published anywhere previously, and it is not simultaneously under consideration for publication by any other journal. Acknowledgements We thank Robert Blakytny, DPhil, from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English language of a draft of this manuscript. Contributors ZL had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: ZL and HTZ. Acquisition, analysis or interpretation of data: ZL, HTZ, JHM, and KL. Drafting of the manuscript: ZL and HTZ. Critical revision of the manuscript for important intellectual content: all authors. Administrative, technical, or material support: ZL, RHW, and KL. Study supervision: ZL. Ethics approval The research protocol complies with the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of the Eye Hospital of Wenzhou Medical University. References Cheung, N.; Mitchell, P.; Wong, T. Y., Diabetic retinopathy. The Lancet 2010, 376 (9735), 124-136. Wang, Y.; Lin, Z.; Wen, L.; Rong, S. S.; Ding, X. X.; Li, D.; Feng, K. M.; Wang, F. H.; Liang, Y. B.; Zhai, G., Rationale, Design, Methodology and Baseline Data of Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT). Ophthalmic Epidemiol 2020, 27 (1), 73-82. Lin, Z.; Wang, F.-H.; Wen, L.; Wang, Y.; Li, D.; Ding, X.-X.; Dou, Y.; Zhai, G.; Liang, Y.-B., Prevalence of and risk factors for diabetic macular edema in a northeastern Chinese population. International Journal of Ophthalmology 2022, 15 (2), 320-326. Wang, W.; Lo, A. C. Y., Diabetic Retinopathy: Pathophysiology and Treatments. International Journal of Molecular Sciences 2018, 19 (6). Mason, J. O.; Colagross, C. T.; Vail, R., Diabetic vitrectomy: risks, prognosis, future trends. Curr Opin Ophthalmol 2006, 17 (3), 281-285. Daruich, A.; Matet, A.; Moulin, A.; Kowalczuk, L.; Nicolas, M.; Sellam, A.; Rothschild, P. R.; Omri, S.; Gelize, E.; Jonet, L.; Delaunay, K.; De Kozak, Y.; Berdugo, M.; Zhao, M.; Crisanti, P.; Behar-Cohen, F., Mechanisms of macular edema: Beyond the surface. Prog Retin Eye Res 2018, 63 , 20-68. Yoshida, S.; Kubo, Y.; Kobayashi, Y.; Zhou, Y.; Nakama, T.; Yamaguchi, M.; Tachibana, T.; Ishikawa, K.; Arita, R.; Nakao, S.; Sassa, Y.; Oshima, Y.; Kono, T.; Ishibashi, T., Increased vitreous concentrations of MCP-1 and IL-6 after vitrectomy in patients with proliferative diabetic retinopathy: possible association with postoperative macular oedema. The British Journal of Ophthalmology 2015, 99 (7), 960-966. Lei, C.; Zhang, Y.; Zhang, M., The association between different hypoglycemic regimens and postoperative diabetic macular edema after vitrectomy in the Japanese patients with proliferative diabetic retinopathy. Front Endocrinol (Lausanne) 2022, 13 , 764254. Lai, T. T.; Huang, J. S.; Yeh, P. T., Incidence and risk factors for cystoid macular edema following scleral buckling. Eye (London, England) 2017, 31 (4), 566-571. Boyer, D. S.; Yoon, Y. H.; Belfort, R.; Bandello, F.; Maturi, R. K.; Augustin, A. J.; Li, X.-Y.; Cui, H.; Hashad, Y.; Whitcup, S. M., Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 2014, 121 (10), 1904-1914. Wu, Q.; Zhang, B.; Hu, Y.; Liu, B.; Cao, D.; Yang, D.; Peng, Q.; Zhong, P.; Zeng, X.; Xiao, Y.; Li, C.; Fang, Y.; Feng, S.; Huang, M.; Cai, H.; Yang, X.; Yu, H., DETECTION OF MORPHOLOGIC PATTERNS OF DIABETIC MACULAR EDEMA USING A DEEP LEARNING APPROACH BASED ON OPTICAL COHERENCE TOMOGRAPHY IMAGES. Retina 2021, 41 (5), 1110-1117. Sun, H.; Zou, W.; Zhang, Z.; Huang, D.; Zhao, J.; Qin, B.; Xie, P.; Mugisha, A.; Liu, Q.; Hu, Z., Vitreous Inflammatory Cytokines and Chemokines, Not Altered After Preoperative Adjunctive Conbercept Injection, but Associated With Early Postoperative Macular Edema in Patients With Proliferative Diabetic Retinopathy. Front Physiol 2022, 13 , 846003. Bae, S. H.; Hwang, J. S.; Yu, H. G., Comparative analysis of macular microstructure by spectral-domain optical coherence tomography before and after silicone oil removal. Retina 2012, 32 (9), 1874-1883. Hostovsky, A.; Mandelcorn, M. S.; Mandelcorn, E. D., Transient Macular Thinning during the Use of Heavy Silicone Oil, Densiron 68. Current Eye Research 2021, 46 (3), 350-354. Doncel-Fernández, C. J.; Alferez-Asenjo, M. L.; Quereda-Castañeda, A.; Castro-Luna, G., Preoperative central macular thickness as a risk factor for pseudophakic macular edema. Graefe's Archive For Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie 2021, 259 (1), 37-43. Gandorfer, A.; Messmer, E. M.; Ulbig, M. W.; Kampik, A., Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina 2000, 20 (2), 126-133. Wu, R.-H.; Xu, M.-N.; Lin, K.; Ren, M.-X.; Wen, H.; Feng, K.-M.; Zhou, H.-J.; Moonasar, N.; Lin, Z., Inner limiting membrane peeling prevents secondary epiretinal membrane after vitrectomy for proliferative diabetic retinopathy. International Journal of Ophthalmology 2022, 15 (9), 1496-1501. Matsunaga, N.; Ozeki, H.; Hirabayashi, Y.; Shimada, S.; Ogura, Y., Histopathologic evaluation of the internal limiting membrane surgically excised from eyes with diabetic maculopathy. Retina 2005, 25 (3), 311-316. Abari, E.; Kociok, N.; Hartmann, U.; Semkova, I.; Paulsson, M.; Lo, A.; Joussen, A. M., Alterations in basement membrane immunoreactivity of the diabetic retina in three diabetic mouse models. Graefe's Archive For Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie 2013, 251 (3), 763-775. Rush, R. B.; Del Valle Penella, A.; Reinauer, R. M.; Rush, S. W.; Bastar, P. G., INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE: A Randomized Clinical Trial. Retina 2021, 41 (5), 1118-1126. Hu, X.-Y.; Liu, H.; Wang, L.-N.; Ding, Y.-Z.; Luan, J., Efficacy and safety of vitrectomy with internal limiting membrane peeling for diabetic macular edema: a Meta-analysis. International Journal of Ophthalmology 2018, 11 (11), 1848-1855. Gelman, R.; Stevenson, W.; Prospero Ponce, C.; Agarwal, D.; Christoforidis, J. B., Retinal Damage Induced by Internal Limiting Membrane Removal. J Ophthalmol 2015, 2015 , 939748. Das, A.; McGuire, P. G.; Rangasamy, S., Diabetic Macular Edema: Pathophysiology and Novel Therapeutic Targets. Ophthalmology 2015, 122 (7), 1375-94. Chung, Y.-R.; Kim, Y. H.; Ha, S. J.; Byeon, H.-E.; Cho, C.-H.; Kim, J. H.; Lee, K., Role of Inflammation in Classification of Diabetic Macular Edema by Optical Coherence Tomography. J Diabetes Res 2019, 2019 , 8164250. Shibuya, M., Differential roles of vascular endothelial growth factor receptor-1 and receptor-2 in angiogenesis. J Biochem Mol Biol 2006, 39 (5), 469-478. Noma, H.; Yasuda, K.; Shimura, M., Involvement of Cytokines in the Pathogenesis of Diabetic Macular Edema. International Journal of Molecular Sciences 2021, 22 (7). Edington, M.; Connolly, J.; Chong, N. V., Pharmacokinetics of intravitreal anti-VEGF drugs in vitrectomized versus non-vitrectomized eyes. Expert Opin Drug Metab Toxicol 2017, 13 (12), 1217-1224. Takamura, Y.; Shimura, M.; Katome, T.; Someya, H.; Sugimoto, M.; Hirano, T.; Sakamoto, T.; Gozawa, M.; Matsumura, T.; Inatani, M., Effect of intravitreal triamcinolone acetonide injection at the end of vitrectomy for vitreous haemorrhage related to proliferative diabetic retinopathy. The British Journal of Ophthalmology 2018, 102 (10), 1351-1357. Shin, H. J.; Lee, S. H.; Chung, H.; Kim, H. C., Association between photoreceptor integrity and visual outcome in diabetic macular edema. Graefe's Archive For Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie 2012, 250 (1), 61-70. Otani, T.; Yamaguchi, Y.; Kishi, S., Correlation between visual acuity and foveal microstructural changes in diabetic macular edema. Retina 2010, 30 (5), 774-780. Additional Declarations There is no conflict of interest Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2821095","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":206022975,"identity":"a3760b29-1592-4e00-a1c9-798a0eb8593c","order_by":0,"name":"Han tao Zhou","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Han","middleName":"tao","lastName":"Zhou","suffix":""},{"id":206022976,"identity":"ecb6832c-7312-4151-8c0a-850be448fcd1","order_by":1,"name":"Jing hao 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14:35:38","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2821095/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2821095/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":38030435,"identity":"29f4acc3-afb5-4b6f-82c8-72a3ccbe5188","added_by":"auto","created_at":"2023-06-05 14:46:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":157539,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2821095/v1/dcf13f2411a3dcbd0f1e6211.png"},{"id":38030436,"identity":"f5aaa318-9f09-476a-9b8d-0a9c007f33b7","added_by":"auto","created_at":"2023-06-05 14:46:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":283213,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2821095/v1/bfc38189454d0ccb3135f46f.png"},{"id":45925819,"identity":"11f4b235-af00-4161-b7aa-595a5ba39e89","added_by":"auto","created_at":"2023-11-06 10:25:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":580847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2821095/v1/8236d89d-a7e8-4cd9-bdc7-46d1962731cd.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"The change of diabetic macular edema post vitrectomy in patients with proliferative diabetic retinopathy","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDiabetic retinopathy (DR) is a major and specific microvascular complication of diabetic mellitus (DM), which remains a leading cause of vision loss and preventable blindness in working-aged adults.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The most common cause of vision loss in patients with DR is proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), with a high prevalence of 4.3%\u003csup\u003e2\u003c/sup\u003e and 15.4%\u003csup\u003e3\u003c/sup\u003e in a Chinese cohort, respectively. Optimal control of blood glucose, blood pressure, and possibly blood lipids remain the foundation for the reduction of the risk of retinopathy development and progression. Current treatment strategies for DR aim at managing microvascular complications, including intravitreal pharmacologic agents and laser photocoagulation.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e However, when DR has progressed to PDR, pars plana vitrectomy (PPV) is needed to offer relief from retinal traction, clearing of media opacities, and stabilization of the proliferation process.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Although advances in modern PPV for PDR have improved visual outcomes, post vitrectomy DME (PV-DME) occurs commonly.\u003c/p\u003e \u003cp\u003eMacular edema (ME) consists of intraretinal or subretinal fluid accumulation in the macular region, a common postoperative complication that can cause severe impairment of central vision.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e A better understanding of PV-DME, particularly its incidence and predisposing risk factors, is necessary to estimate the clinical burden and develop a preventative strategy for this complication. However, there is little information in the current literature regarding PV-DME. Yoshida \u003cem\u003eet al\u003c/em\u003e showed that the elevated monocyte chemoattractant protein-1 (MCP-1) and interleukin (IL)-6 levels after PPV may indicate prolonged inflammation, which can cause postoperative DME.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e A recent study reported that insulin treatment may reduce the risk of postoperative DME.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e However, PV-DME incidence and onset time were not accessed among these studies. Moreover, because of the preoperative media opacification, preoperative DME was unable to be evaluated.\u003c/p\u003e \u003cp\u003eWith respect to the above, the purpose of this study was to investigate the incidence of newly developed PV-DME and the factors affecting its development. We also evaluated the effect of PPV on patients with preoperative DME.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis is a retrospective study on patients with PDR who underwent PPV from January 2018 to March 2022 at a tertiary medical center. The research protocol complies with the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of the Eye Hospital of Wenzhou Medical University. The informed consent was waived. The patients\u0026rsquo; clinical information was obtained from archived electronic medical records.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were: 1) patients who underwent PPV for PDR from January 2018 to March 2022; 2) a 3-month or longer follow-up after surgery; 3) gradable optical coherence tomography (OCT) imaging before surgery. The exclusion criteria were: 1) silicone oil tamponade; 2) a history of PPV; 3) any intraocular surgery within 3 months prior to and after this PPV; 4) other ocular conditions that may be responsible for the ME, such as uveitis, retinal vein occlusion, and ocular trauma; 5) patients with a serious postoperative complication, such as neovascular glaucoma and retinal artery occlusion; 6) a history of penetrating ocular trauma.\u003c/p\u003e \u003cp\u003eThe 23- or 25-gauge PPVs were performed under retrobulbar (50% mixture of 2% lidocaine and 0.75% bupivacaine) or general anesthesia using two different vitrectomy machines (Stellaris PC, Bausch \u0026amp; Lomb, Bridgewater Township, NJ; Constellation Vision System, Alcon Laboratories). Additional internal limiting membrane (ILM) peeling, epiretinal membrane (ERM) peeling, or other procedures (PRP, gas injection, combined cataract surgery, intraocular lens implantation, etc.) were performed according to the surgeon\u0026rsquo;s experience.\u003c/p\u003e \u003cp\u003eWe used spectral-domain OCT (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany) with a 30\u0026deg; scanning angle (9\u0026times;9 mm) at the central macula for image acquisition and the analysis protocol. Central retinal thickness (CRT) was measured at the central 1-mm region of the standard Early Treatment Diabetic Retinopathy Study subfield. The diagnosis of PV-DME was confirmed if the OCT imaging of the macular showed typical findings of retinal thickening (CRT\u0026thinsp;\u0026ge;\u0026thinsp;300 \u0026micro;m)\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e among patients without preoperative DME. There were three OCT patterns of DME, which was diffused retinal thickening (DRT) as a sponge-like retinal swelling of the macula with reduced intraretinal reflectivity, cystoid macular edema (CME) as intraretinal cystoid spaces of low reflectivity and highly reflective septa separating cystoid-like cavities in the macular area, and serous retinal detachment (SRD) as a shallow elevation of the retina and an optically clear space between the neurosensory retina and retinal pigment epithelium.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The OCT images of mixed DME patterns, defined as the mixture of two of these OCT patterns, were also included in our study. The presence of ERM, tractional retinal detachment, and posterior hyaloidal traction were also determined.\u003c/p\u003e \u003cp\u003ePDR was classified into three stages: stage 1: neovascularization of the retina, vitreous hemorrhage or preretinal hemorrhage; stage 2: neovascularization of the retina, and fibrovascular membranes; stage 3: stage 2 plus tractional retinal detachment.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS (IBM, Armonk, NY, version 25.0). A Kaplan\u0026ndash;Meier survival curve was constructed to show the cumulative incidence of newly developed postoperative DME. Multiple comparisons were performed with repeated measures analysis of variance, followed by Bonferroni multiple comparison test to compare the CRT between pre-operation, 7 days, 1 month, and 3 months after surgery. Univariate analysis of categorical variables was performed by the chi-square test or Fisher exact test. Independent t-test was used to compare the mean values of normally distributed variables. All variables with a P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate Cox regression analysis or variables considered clinically meaningful were entered into multivariate Cox regression analysis to determine the risk factors for PV-DME. All variables with a P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate liner regression analysis or variables considered clinically meaningful were entered into multivariate liner regression analysis to determine the risk factors for the change of CRT from pre-operation to 3 months postoperatively. Statistical significance was determined using a threshold of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 365 eyes from 330 patients (male 196, 59.3%) who underwent PPV for PDR were enrolled in this study. The mean age of the patients was 57.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3 years. All patients were divided into two groups according to the presence of DME before surgery. Group A (n\u0026thinsp;=\u0026thinsp;222) were the patients without preoperative DME; Group B (n\u0026thinsp;=\u0026thinsp;143) were the patients with preoperative DME.\u003c/p\u003e \u003cp\u003eIn Group A, patients with postoperative DME were younger (P\u0026thinsp;=\u0026thinsp;0.02), had a greater preoperative CRT (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), higher proportion of males (P\u0026thinsp;=\u0026thinsp;0.01), higher proportion of preoperative intravitreal injection of anti-VEGF (anti-vascular endothelial growth factor) (P\u0026thinsp;=\u0026thinsp;0.026), higher proportion of intraoperative ILM peeling (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and higher proportion of intraoperative intravitreal injection (P\u0026thinsp;=\u0026thinsp;0.004). By contrast, no statistical significance was found in Group B (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and clinical characteristics of patients with and without preoperative diabetic macular edema\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eGroup A: Preoperative ME (-)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;222)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eGroup B: Preoperative ME (+)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePostoperative ME (-)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;133)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePostoperative ME (+)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePostoperative ME (-)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePostoperative ME (+)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.00\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e61.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e59.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (49.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (66.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65 (58.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStage of PDR\u003c/p\u003e \u003cp\u003eStage 1\u003c/p\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (36.8)\u003c/p\u003e \u003cp\u003e50 (37.6)\u003c/p\u003e \u003cp\u003e34 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (33.7)\u003c/p\u003e \u003cp\u003e38 (42.7)\u003c/p\u003e \u003cp\u003e21 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (35.5)\u003c/p\u003e \u003cp\u003e14 (45.2)\u003c/p\u003e \u003cp\u003e6 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37 (33.0)\u003c/p\u003e \u003cp\u003e51 (45.5)\u003c/p\u003e \u003cp\u003e24 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDuration of DM\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 years\u003c/p\u003e \u003cp\u003e10\u0026thinsp;~\u0026thinsp;20 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (24.1)\u003c/p\u003e \u003cp\u003e62 (46.6)\u003c/p\u003e \u003cp\u003e39 (29.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (34.8)\u003c/p\u003e \u003cp\u003e31 (46.1)\u003c/p\u003e \u003cp\u003e17 (19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (22.6)\u003c/p\u003e \u003cp\u003e18 (58.1)\u003c/p\u003e \u003cp\u003e6 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35 (31.3)\u003c/p\u003e \u003cp\u003e52 (46.4)\u003c/p\u003e \u003cp\u003e25 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInsulin treatment\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (51.1)\u003c/p\u003e \u003cp\u003e65 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (61.8)\u003c/p\u003e \u003cp\u003e34 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18 (58.1)\u003c/p\u003e \u003cp\u003e13 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69 (61.6)\u003c/p\u003e \u003cp\u003e43 (38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFPG (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative CRT (\u0026micro;m)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201.7\u0026thinsp;\u0026plusmn;\u0026thinsp;43.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e228.0\u0026thinsp;\u0026plusmn;\u0026thinsp;36.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e436.3\u0026thinsp;\u0026plusmn;\u0026thinsp;171.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e475.7\u0026thinsp;\u0026plusmn;\u0026thinsp;179.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePattern of preoperative ME\u003c/p\u003e \u003cp\u003eCME\u003c/p\u003e \u003cp\u003eDRT\u003c/p\u003e \u003cp\u003eCME\u0026thinsp;+\u0026thinsp;SRD\u003c/p\u003e \u003cp\u003eDRT\u0026thinsp;+\u0026thinsp;SRD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (25.4)\u003c/p\u003e \u003cp\u003e13 (21.3)\u003c/p\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e47 (74.6)\u003c/p\u003e \u003cp\u003e48 (78.7)\u003c/p\u003e \u003cp\u003e14 (87.5)\u003c/p\u003e \u003cp\u003e3 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative ERM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e52 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePreoperative Intravitreal injection of anti-VEGF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49 (53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoperative ERM peeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18 (58.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoperative ILM peeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (45.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e92 (82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoperative Combined cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (87.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25 (80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e97 (86.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoperative PRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88 (98.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28 (90.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e104 (92.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoperative Intravitreal injection\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eAnti-VEGF\u003c/p\u003e \u003cp\u003eTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (57.9)\u003c/p\u003e \u003cp\u003e7 (5.3)\u003c/p\u003e \u003cp\u003e49 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (83.1)\u003c/p\u003e \u003cp\u003e6 (6.7)\u003c/p\u003e \u003cp\u003e9 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (61.3)\u003c/p\u003e \u003cp\u003e1 (3.2)\u003c/p\u003e \u003cp\u003e11 (35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e71 (63.4)\u003c/p\u003e \u003cp\u003e11 (9.8)\u003c/p\u003e \u003cp\u003e30 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePostoperative pattern of ME\u003c/p\u003e \u003cp\u003eCME\u003c/p\u003e \u003cp\u003eDRT\u003c/p\u003e \u003cp\u003eCME\u0026thinsp;+\u0026thinsp;SRD\u003c/p\u003e \u003cp\u003eDRT\u0026thinsp;+\u0026thinsp;SRD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (27)\u003c/p\u003e \u003cp\u003e59 (66.3)\u003c/p\u003e \u003cp\u003e3 (3.4)\u003c/p\u003e \u003cp\u003e3 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35 (31.3)\u003c/p\u003e \u003cp\u003e63 (56.3)\u003c/p\u003e \u003cp\u003e11 (9.8)\u003c/p\u003e \u003cp\u003e3 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eContinual variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; classified variables are presented as number and percentage.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eME: macular edema; PDR: proliferative diabetic retinopathy; DM: diabetes mellitus; FPG: fasting plasma glucose; CRT: central retinal thickness; CME: cystoid macular edema; DRT: diffused retinal thickening; SRD: serous retinal detachment; ERM: epiretinal membrane; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn Group A, the cumulative incidence of PV-DME within a 3-month follow-up period are presented in Fig.\u0026nbsp;1. The cumulative incidence at 3 months was 40.1% (89/222). Of the 89 eyes with postoperative DME, 24 eyes (27.0%) displayed CME alone, 59 eyes (66.2%) showed DRT alone, 3 (3.4%) displayed CME and SRD, and 3 (3.4%) showed DRT and SRD.\u003c/p\u003e \u003cp\u003eIn Group B, before PPV, 63 eyes (44.0%) displayed CME alone, 61 eyes (42.7%) showed DRT alone, 16 (11.2%) displayed CME and SRD, and 3 (2.1%) showed DRT and SRD preoperatively. After PPV, 112 eyes (78.3%) retained ME within the 3-month follow-up period. Of these 112 eyes, the numbers of CME alone, DRT alone, CME and SRD, and DRT and SRD were 35 (31.3%), 63 (56.3%), 11 (9.8%), and 3 (2.7%), respectively.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the incidence of PV-DME in Group A. Male patients (P\u0026thinsp;=\u0026thinsp;0.01) and patients with a thicker preoperative CRT (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with preoperative intravitreal injection of anti-VEGF (P\u0026thinsp;=\u0026thinsp;0.03), with intraoperative ILM peeling (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), or without intraoperative intravitreal injection of triamcinolone acetonide (TA) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had a higher incidence of PV-DME.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of post vitrectomy diabetic macular edema in patients without preoperative diabetic macular edema\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncidence of PV-DME (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;55 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;55 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (46.3)\u003c/p\u003e \u003cp\u003e127 (35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (47.2)\u003c/p\u003e \u003cp\u003e97 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage of PDR\u003c/p\u003e \u003cp\u003eStage 1\u003c/p\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (38.0)\u003c/p\u003e \u003cp\u003e88 (43.2)\u003c/p\u003e \u003cp\u003e55 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of DM\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 years\u003c/p\u003e \u003cp\u003e10\u0026thinsp;~\u0026thinsp;20 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (49.2)\u003c/p\u003e \u003cp\u003e103 (39.8)\u003c/p\u003e \u003cp\u003e56 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsulin treatment\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123 (44.7)\u003c/p\u003e \u003cp\u003e99 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG\u003c/p\u003e \u003cp\u003e\u0026le;\u0026thinsp;6.1 mmol/L\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6.1 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (41.2)\u003c/p\u003e \u003cp\u003e165 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6.5%\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (30.0)\u003c/p\u003e \u003cp\u003e192 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CRT\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;212.50 \u0026micro;m\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;212.50 \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (26.4)\u003c/p\u003e \u003cp\u003e112 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative ERM\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196 (39.8)\u003c/p\u003e \u003cp\u003e26 (42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Intravitreal injection of anti-VEGF\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (33.3)\u003c/p\u003e \u003cp\u003e102 (48.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative ERM peeling\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e203 (39.4)\u003c/p\u003e \u003cp\u003e19(47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative ILM peeling\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (21.7)\u003c/p\u003e \u003cp\u003e130 (53.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Combined cataract surgery\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (34.3)\u003c/p\u003e \u003cp\u003e190 (41.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative PRP\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (14.3)\u003c/p\u003e \u003cp\u003e215 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Intravitreal injection\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eAnti-VEGF\u003c/p\u003e \u003cp\u003eTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151 (49.0)\u003c/p\u003e \u003cp\u003e13 (46.2)\u003c/p\u003e \u003cp\u003e58 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003ePV-DME: post vitrectomy diabetic macular edema; PDR: proliferative diabetic retinopathy; DM: diabetes mellitus; FPG: fasting plasma glucose; CRT: central retinal thickness; ERM: epiretinal membrane; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the changes in CRT in Group B. Patients with a thicker preoperative CRT displayed a significant association with the greater changes in CRT (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in central retinal thickness in patients with preoperative diabetic macular edema\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChanges of CRT (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, \u0026micro;m)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;55 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;55 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114.5\u0026thinsp;\u0026plusmn;\u0026thinsp;192.3\u003c/p\u003e \u003cp\u003e93.7\u0026thinsp;\u0026plusmn;\u0026thinsp;203.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.3\u0026thinsp;\u0026plusmn;\u0026thinsp;196.2\u003c/p\u003e \u003cp\u003e132.6\u0026thinsp;\u0026plusmn;\u0026thinsp;201.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage of PDR\u003c/p\u003e \u003cp\u003eStage 1\u003c/p\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.8\u0026thinsp;\u0026plusmn;\u0026thinsp;173.0\u003c/p\u003e \u003cp\u003e116.4\u0026thinsp;\u0026plusmn;\u0026thinsp;199.0\u003c/p\u003e \u003cp\u003e104.0\u0026thinsp;\u0026plusmn;\u0026thinsp;240.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of DM\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 years\u003c/p\u003e \u003cp\u003e10\u0026thinsp;~\u0026thinsp;20 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104.0\u0026thinsp;\u0026plusmn;\u0026thinsp;174.9\u003c/p\u003e \u003cp\u003e100.0\u0026thinsp;\u0026plusmn;\u0026thinsp;213.3\u003c/p\u003e \u003cp\u003e92.48\u0026thinsp;\u0026plusmn;\u0026thinsp;205.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsulin treatment\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.7\u0026thinsp;\u0026plusmn;\u0026thinsp;208.1\u003c/p\u003e \u003cp\u003e105.5\u0026thinsp;\u0026plusmn;\u0026thinsp;187.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG\u003c/p\u003e \u003cp\u003e\u0026le;\u0026thinsp;6.1 mmol/L\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6.1 mmol/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.4\u0026thinsp;\u0026plusmn;\u0026thinsp;148.4\u003c/p\u003e \u003cp\u003e108.4\u0026thinsp;\u0026plusmn;\u0026thinsp;207.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;6.5%\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175.5\u0026thinsp;\u0026plusmn;\u0026thinsp;195.4\u003c/p\u003e \u003cp\u003e91.6\u0026thinsp;\u0026plusmn;\u0026thinsp;199.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CRT\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;450 \u0026micro;m\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;450 \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;125.1\u003c/p\u003e \u003cp\u003e222.3\u0026thinsp;\u0026plusmn;\u0026thinsp;237.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative ERM\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.0\u0026thinsp;\u0026plusmn;\u0026thinsp;233.0\u003c/p\u003e \u003cp\u003e111.6\u0026thinsp;\u0026plusmn;\u0026thinsp;159.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Intravitreal injection of anti-VEGF\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122.5\u0026thinsp;\u0026plusmn;\u0026thinsp;216.2\u003c/p\u003e \u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;170.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative ERM peeling\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.7\u0026thinsp;\u0026plusmn;\u0026thinsp;227.3\u003c/p\u003e \u003cp\u003e120.4\u0026thinsp;\u0026plusmn;\u0026thinsp;158.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative ILM peeling\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.6\u0026thinsp;\u0026plusmn;\u0026thinsp;263.5\u003c/p\u003e \u003cp\u003e102.3\u0026thinsp;\u0026plusmn;\u0026thinsp;183.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Combined cataract surgery\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100.4\u0026thinsp;\u0026plusmn;\u0026thinsp;142.7\u003c/p\u003e \u003cp\u003e99.4\u0026thinsp;\u0026plusmn;\u0026thinsp;208.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative PRP\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91.18\u0026thinsp;\u0026plusmn;\u0026thinsp;87.3\u003c/p\u003e \u003cp\u003e100.2\u0026thinsp;\u0026plusmn;\u0026thinsp;206.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Intravitreal injection\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eAnti-VEGF\u003c/p\u003e \u003cp\u003eTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.93\u0026thinsp;\u0026plusmn;\u0026thinsp;187.5\u003c/p\u003e \u003cp\u003e170.2\u0026thinsp;\u0026plusmn;\u0026thinsp;176.7\u003c/p\u003e \u003cp\u003e117.5\u0026thinsp;\u0026plusmn;\u0026thinsp;228.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eSD: standard deviation; PDR: proliferative diabetic retinopathy; DM: diabetes mellitus; FPG: fasting plasma glucose; CRT: central retinal thickness; ERM: epiretinal membrane; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure 2 presents the changes of CRT over time in Group B during the 3-month follow-up period. The CRT decreased gradually from 468.3\u0026thinsp;\u0026plusmn;\u0026thinsp;177.7 \u0026micro;m preoperatively to 409.5\u0026thinsp;\u0026plusmn;\u0026thinsp;151.0 \u0026micro;m (P\u0026thinsp;=\u0026thinsp;0.03), 377.4\u0026thinsp;\u0026plusmn;\u0026thinsp;141.9 \u0026micro;m (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and 368.0\u0026thinsp;\u0026plusmn;\u0026thinsp;157.6 \u0026micro;m (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) at 7 days, 1 month, and 3 months postoperatively, respectively.\u003c/p\u003e \u003cp\u003eMultivariate Cox regression analysis was performed to determine the risk factors for PV-DME, and found that a thicker preoperative CRT (HR\u0026thinsp;=\u0026thinsp;1.01, 95% CI 1.00 to 1.02), intraoperative ILM peeling (HR\u0026thinsp;=\u0026thinsp;3.19, 95% CI 1.85 to 5.49), and intraoperative intravitreal TA injection (HR\u0026thinsp;=\u0026thinsp;0.28, 95% CI 0.13 to 0.57) were associated with PV-DME (Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate Cox regression analysis of risk factors for post vitrectomy diabetic macular edema in patients without preoperative diabetic macular edema\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMulti-factor analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.98 (0.96 to 1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.79 (0.50 to 1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82 (0.60 to 1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01 (1.00 to 1.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative Intravitreal injection of anti-VEGF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.85 (0.52 to 1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative ILM peeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.19 (1.85 to 5.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative intravitreal injection\u003c/p\u003e \u003cp\u003eIntraoperative intravitreal injection (anti-VEGF)\u003c/p\u003e \u003cp\u003eIntraoperative intravitreal injection (TA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92 (0.38 to 2.21)\u003c/p\u003e \u003cp\u003e0.28 (0.13 to 0.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eDM: diabetes mellitus; CRT: central retinal thickness; Anti-VEGF: anti-vascular endothelial growth factor; ILM: internal limiting membrane; TA: triamcinolone acetonide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo determine the risk factors influencing the amount of postoperative CRT change in Group B, multivariate linear regression analysis was performed. Only a thicker preoperative CRT (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.77, 95% CI 0.63 to 0.92) was found to be associated with a decreasing postoperative CRT (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate linear regression analysis of risk factors influencing the amount of central retinal thickness change from pre-operation to 3 months postoperatively in patients with preoperative diabetic macular edema\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMulti-factor analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.30 (-3.87 to 1.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.76 (-16.87 to 86.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage of PDR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-12.06 (-49.16 to 25.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.08 (-14.41 to 22.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFPG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.41 (-13.77 to 4.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative CRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.77 (0.63 to 0.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative intravitreal injection of anti-VEGF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-13.67 (-73.38 to 46.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative ILM peeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.02 (-28.63 to 106.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative combined cataract surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-14.53 (-85.77 to 56.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative PRP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-16.59 (-120.94 to 87.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative Intravitreal injection\u003c/p\u003e \u003cp\u003eIntraoperative Intravitreal injection (anti-VEGF)\u003c/p\u003e \u003cp\u003eIntraoperative Intravitreal injection (TA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-24.06 (-127.86 to 79.75)\u003c/p\u003e \u003cp\u003e-24.36 (-85.65 to 36.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003ePDR: proliferative diabetic retinopathy; FPG: fasting plasma glucose; CRT: central retinal thickness; ILM: internal limiting membrane; PRP: panretinal photocoagulation; Anti-VEGF: anti-vascular endothelial growth factor; TA: triamcinolone acetonide.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWhen using the criterion of a CRT\u0026thinsp;\u0026ge;\u0026thinsp;300 \u0026micro;m, the present study found a very high incidence of PV-DME of 40.1%, with the majority subtype being DRT alone (66.2%), followed by CME alone (27.0%). This high incidence indicated that 40% of PDR patients may need further treatment, such as intravitreal drug injection, to regain visual function even after PPV. Although a direct comparison was difficult, the current reported incidence was higher than in other studies. A retrospective cohort study showed that of the 124 eyes that underwent PPV for PDR, 10 eyes (8.06%) presented postoperative ME.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Sun \u003cem\u003eet al\u003c/em\u003e conducted a study focused on the effect of preoperative injection on vitreous inflammatory cytokines and chemokines and showed that 20 eyes (33.90%) presented ME.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e In contrast with previous studies, we excluded patients with an unreadable preoperative OCT image and postoperative silicone oil tamponade to focus on the incidence of PV-DME. Patients frequently required the removal of the silicone oil within the 3-month follow-up, and the silicone oil frequently led to decreased macular thickness and microstructural changes.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Moreover, the definition of ME was different among studies. For example, Sun \u003cem\u003eet al\u003c/em\u003e determined the presence of ME only by the macular structure (such as DRT, SRD, and CME), but not CRT measurement.\u003c/p\u003e \u003cp\u003eIn the present study, the preoperative CRT and intraoperative ILM peeling were independent risk factors for newly developed PV-DME, while intraoperative TA injection prevented PV-DME. Doncel-Fern\u0026aacute;ndez \u003cem\u003eet al\u003c/em\u003e reported that patients without known risk factors for developing CME and major surgical complication presented 9.08 times more probability to develop pseudophakic ME when with a preoperative central macular thickness\u0026thinsp;\u0026gt;\u0026thinsp;260.5 \u0026micro;m.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In the present study, a thicker preoperative CRT was also found to be associated with PV-DME.\u003c/p\u003e \u003cp\u003eWhether ILM peeling improves anatomical and functional outcomes has been extensively studied. It has been reported that additional removal of the ILM at the time of PPV may be helpful by removing all tractional forces, inhibiting the reproliferation of fibrous astrocytes,\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e and preventing postoperative ERM formation.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Additionally, the mean thickness of the ILM was significantly higher in diabetic patients, which may disturb the outflow of fluids accumulating into the retina and limit the diffusion of oxygen from the vitreous.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e ILM removal improves exchanges with the oxygen-rich vitreous and promotes the discharge of liquid from the retina. A recent randomized clinical trial showed that the patients who underwent ILM peeling had a better best-corrected visual acuity and a lower incidence of ERM at 6 months than patients without ILM peeling.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e There was also a trend towards lower central macular thickness on OCT and a lower incidence of DME treatment postoperatively.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Hu \u003cem\u003eet al\u003c/em\u003e indicated that compared with vitrectomy alone, vitrectomy with ILM peeling had higher rate of CRT reduction in patients with DME.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e However, the result of our study showed that the patients who underwent ILM peeling during PPV were more likely to present PV-DME. Given the close proximity of the ILM to the inner retina and its interdigitation with M\u0026uuml;ller cell footplates, ILM peeling would unavoidably cause damage to M\u0026uuml;ller cells.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e M\u0026uuml;ller cells release factors that induce tight junction formation in retinal vessels. Abnormalities in M\u0026uuml;ller cells caused by ILM peeling probably affect this barrier property in the retinal vessels.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e In addition, the role of M\u0026uuml;ller cells in controlling the movement of water and ions allows them to buffer intraretinal increases of potassium ions. Ischemia and inflammation can alter the potassium channels of M\u0026uuml;ller cells and cause them to accumulate intracellular fluid.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Moreover, we considered that during the procedure of ILM peeling, additional traction was applied to the retina, causing PV-DME. Chromophore toxicity, inflammation, and ganglion cell damage caused by ILM peeling, and the vulnerable vascular bed, lower integrity of the endothelium, and the loss of pericytes of patients with diabetes also contribute to PV-DME development.\u003c/p\u003e \u003cp\u003eThe current first-line treatment for DME is the intravitreal injection of anti-VEGF agent, because of its apparent effect in reducing the VEGF level, and a certain effect on the decrease in the levels of downstream inflammatory cytokines.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e However, unexpectedly, neither preoperative nor intraoperative intravitreal anti-VEGF injection was found to prevent PV-DME in the present study. It has been reported that after preoperative intravitreal anti-VEGF injection, the VEGF level dramatically decreased, whereas the influence on the vitreous inflammatory cytokines and chemokines in PDR was limited.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Moreover, the decreased half-lives and increased clearance of anti-VEGF drugs in vitrectomized eyes probably also contribute.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Despite the preoperative intravitreal injection of anti-VEGF agent, a series of cytokines, including IL-1β, TNF-α, CXCL9, G-CSF, MCP-1, and RANTES, remained at a high level and may lead to PV-DME.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Yoshida \u003cem\u003eet al\u003c/em\u003e reported that elevated MCP-1 and IL-6 levels may indicate prolonged inflammation even after successful vitrectomy, which was significantly associated with PV-DME.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Rather than with an anti-VEGF agent, we found an intraoperative intravitreal TA injection effectively prevented PV-DME development in this study. Takamura \u003cem\u003eet al\u003c/em\u003e reported that intravitreal TA injection at the end of vitrectomy may inhibit postoperative inflammation and ME, which was consistent with our study.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Intraoperative intravitreal TA injection can effectively inhibit inflammatory cytokine production, leukostasis, and the phosphorylation of cell-junction proteins.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFor patients with preoperative DME, 78.3% of them retained DME during the 3 months after PPV in the present study. Fortunately, the mean CRT displayed a stable trend for reduction after PPV. A greater reduction of CRT in these patients was associated with a thicker preoperative CRT, which may be due to a greater potential for CRT reduction in these patients after surgery. However, intraoperative ILM peeling and intravitreal anti-VEGF or TA injection were not found to be associated with CRT reduction. Patients with DME frequently display retinal structural abnormalities, including ellipsoid zone disruption, external limiting membrane disruption, and blood-retinal barrier breakdown, compared with patients without DME.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Therefore, ILM peeling appears insignificant for exacerbating the macular microstructure. Patients with preoperative DME frequently require a long time and multiple anti-VEGF treatments. Therefore, a single operative injection may not be sufficient.\u003c/p\u003e \u003cp\u003eOur study has some strengths. First, we reported the incidence of PV-DME and DME progression after PPV in a large sample size of PDR patients. Second, preoperative and postoperative macular morphology and CRT were precisely evaluated by OCT. This study also has several limitations. First, due to the retrospective design, there were considerable discrepancies in surgical methods and the follow-up time. Second, the incidence of PV-DME may be overestimated. Patients excluded from this study tended to have poor follow-up. These patients probably had a good visual outcome and less severe DME.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePV-DME is a very common postoperative complication in patients with PDR. TA could prevent its formation. Particular attention should be paid to patients with a thicker preoperative CRT and ILM peeling.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFinancial Support\u0026nbsp;\u003c/strong\u003eThis study was supported by the Zhejiang Provincial High-level health talents Training Project (CZ-RC2022010) and Wenzhou Basic Medical and Health Technology Project (Y20220779).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eDeclaration of interest\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest. This manuscript has not been published anywhere previously, and it is not simultaneously under consideration for publication by any other journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eWe thank Robert Blakytny, DPhil, from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English language of a draft of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eContributors\u003c/strong\u003e ZL had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: ZL and HTZ. Acquisition, analysis or interpretation of data: ZL, HTZ, JHM, and KL. Drafting of the manuscript: ZL and HTZ. Critical revision of the manuscript for important intellectual content: all authors. Administrative, technical, or material support: ZL, RHW, and KL. Study supervision: ZL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e The research protocol complies with the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of the Eye Hospital of Wenzhou Medical University.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCheung, N.; Mitchell, P.; Wong, T. Y., Diabetic retinopathy. \u003cem\u003eThe Lancet \u003c/em\u003e\u003cstrong\u003e2010,\u003c/strong\u003e \u003cem\u003e376\u003c/em\u003e (9735), 124-136.\u003c/li\u003e\n\u003cli\u003eWang, Y.; Lin, Z.; Wen, L.; Rong, S. S.; Ding, X. X.; Li, D.; Feng, K. M.; Wang, F. H.; Liang, Y. 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V., Pharmacokinetics of intravitreal anti-VEGF drugs in vitrectomized versus non-vitrectomized eyes. \u003cem\u003eExpert Opin Drug Metab Toxicol \u003c/em\u003e\u003cstrong\u003e2017,\u003c/strong\u003e \u003cem\u003e13\u003c/em\u003e (12), 1217-1224.\u003c/li\u003e\n\u003cli\u003eTakamura, Y.; Shimura, M.; Katome, T.; Someya, H.; Sugimoto, M.; Hirano, T.; Sakamoto, T.; Gozawa, M.; Matsumura, T.; Inatani, M., Effect of intravitreal triamcinolone acetonide injection at the end of vitrectomy for vitreous haemorrhage related to proliferative diabetic retinopathy. \u003cem\u003eThe British Journal of Ophthalmology \u003c/em\u003e\u003cstrong\u003e2018,\u003c/strong\u003e \u003cem\u003e102\u003c/em\u003e (10), 1351-1357.\u003c/li\u003e\n\u003cli\u003eShin, H. J.; Lee, S. H.; Chung, H.; Kim, H. C., Association between photoreceptor integrity and visual outcome in diabetic macular edema. \u003cem\u003eGraefe\u0026apos;s Archive For Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie \u003c/em\u003e\u003cstrong\u003e2012,\u003c/strong\u003e \u003cem\u003e250\u003c/em\u003e (1), 61-70.\u003c/li\u003e\n\u003cli\u003eOtani, T.; Yamaguchi, Y.; Kishi, S., Correlation between visual acuity and foveal microstructural changes in diabetic macular edema. \u003cem\u003eRetina \u003c/em\u003e\u003cstrong\u003e2010,\u003c/strong\u003e \u003cem\u003e30\u003c/em\u003e (5), 774-780.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"diabetic macular edema, proliferative diabetic retinopathy, vitrectomy","lastPublishedDoi":"10.21203/rs.3.rs-2821095/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2821095/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo investigate the change of diabetic macular edema (DME) post vitrectomy and its risk factors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eRetrospective study design. This study included 365 eyes of 330 patients who underwent vitrectomy for proliferative diabetic retinopathy with gradable optical coherence tomography imaging from January 2018 to March 2022. The incidence of post vitrectomy DME (PV-DME) was defined as patients with a central retinal thickness (CRT)\u0026thinsp;\u0026gt;\u0026thinsp;300 \u0026micro;m by optical coherence tomography among patients without preoperative DME.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe cumulative incidence of PV-DME at 3 months was 40.1% (89/222), with its majority subtype of single diffused retinal thickening (66.2%) followed by single cystoid macular edema (27.0%). Multivariate Cox regression analysis indicated that a thicker preoperative CRT (HR\u0026thinsp;=\u0026thinsp;1.01, 95% CI 1.00\u0026ndash;1.02) and intraoperative internal limiting membrane peeling (HR\u0026thinsp;=\u0026thinsp;3.18, 95% CI 1.85\u0026ndash;5.47) were associated with the presence of PV-DME, while intraoperative intravitreal injection of triamcinolone acetonide (HR\u0026thinsp;=\u0026thinsp;0.28, 95% CI 0.13\u0026ndash;0.57) was protective against PV-DME. In eyes with preoperative DME (n\u0026thinsp;=\u0026thinsp;143), the CRT decreased gradually from 468.3\u0026thinsp;\u0026plusmn;\u0026thinsp;177.7 \u0026micro;m preoperatively to 409.5\u0026thinsp;\u0026plusmn;\u0026thinsp;151.0 \u0026micro;m (P\u0026thinsp;=\u0026thinsp;0.027), 377.4\u0026thinsp;\u0026plusmn;\u0026thinsp;141.9 \u0026micro;m (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and 368.0\u0026thinsp;\u0026plusmn;\u0026thinsp;157.6 \u0026micro;m (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) at 7 days, 1 month, and 3 months postoperatively, respectively. Multivariate linear regression analysis indicated that only a thicker preoperative CRT (β\u0026thinsp;=\u0026thinsp;0.77, 95% CI 0.63\u0026ndash;0.92) was associated with a decreasing postoperative CRT.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePV-DME is a very common postoperative complication in patients with proliferative diabetic retinopathy. Triamcinolone acetonide could prevent its formation. Attention should be paid to patients with a thicker preoperative CRT and internal limiting membrane peeling.\u003c/p\u003e","manuscriptTitle":"The change of diabetic macular edema post vitrectomy in patients with proliferative diabetic retinopathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-05 14:46:06","doi":"10.21203/rs.3.rs-2821095/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a1c2af8-86c9-458b-9a17-07e97d1019cd","owner":[],"postedDate":"June 5th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-11-06T10:17:29+00:00","versionOfRecord":[],"versionCreatedAt":"2023-06-05 14:46:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2821095","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2821095","identity":"rs-2821095","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}