Recurrent retinal detachment after diabetic vitrectomy

Refining vitrectomy for proliferative diabetic retinopathy

Pars plana vitrectomy (PPV) is the main treatment modality for patients with severe diabetic retinopathy. With the development of systems for microincision, wide-angle viewing, digitally assisted visualization, and intraoperative optical coherence tomography, contemporary PPV for diabetic retinopathy has been performed on a wider range of indications than previously considered. In this article, we reviewed, in conjunction with our collective experiences with Asian patients, the applications of new technologies for PPV in eyes with diabetic retinopathy and highlighted several important procedures and entities not generally reiterated in the literature, in order for vitreoretinal surgeons to optimize their approaches when facing the challenges imposed by the complications in diabetic eyes.

Efficacy of Intravitreal Dexamethasone After Combined Phacoemulsification and Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachments

Purpose: To evaluate the efficacy and complications of intravitreal dexamethasone with simultaneous silicone tamponade after combined phacoemulsification and pars plana vitrectomy (PPV) in severe diabetic tractional retinal detachments (TRDs). Methods: In this single center, prospective, randomized, and open labeled 2 parallel group study, patients who applied to our clinic due to diabetic TRD involving the macula with grade-3 and 4 cataracts were randomized to receive either simultaneous silicone tamponade and intravitreal dexamethasone (Group-1) or only silicone tamponade (Group-2). Primary outcome measurements were the incidence rate of retinal re-detachment and, proliferative vitreoretinopathy (PVR) at sixth month, and anterior segment inflammation and posterior iris synechia at first and at sixth months. Results: We operated 22 eyes of 22 patients in Group-1 (PPV with dexamethasone implant) and 21 eyes of 21 patients in Group-2 (PPV without dexamethasone implant). The rate of re-detachment and PVR were significantly higher in the Group-2 compared with in Group-1 at sixth month (Group-1, 0/22, Group-2, 6/21 28.6%, P = 0.038). Anterior chamber fibrin exudation at first month was significantly superior in the Group-2 (Group-1, 0/22, Group-2, 8/21 38.0%, P = 0.021). Posterior iris synechia was more observed in the Group-2 at sixth month (Group-1, 0/22, Group-2, 7/21 33.3%, P = 0.029). Conclusions: Dexamethasone implant at the end of combined phacoemulsification and PPV with silicon oil tamponade in patients with diabetic TRD reduces retinal re-detachment, anterior chamber fibrin exudation and posterior iris synechia. This approach can be an alternative option in the treatment of diabetic TRD with coexisting cataracts.