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Duong RT, Cai X, Ambati NR, Shildkrot YE. Clinical Outcomes of 27-Gauge Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment Repair. JOURNAL OF VITREORETINAL DISEASES 2023; 7:281-289. [PMID: 37927313 PMCID: PMC10621701 DOI: 10.1177/24741264231169145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: To analyze the clinical outcomes of 27-gauge pars plana vitrectomy (PPV) repair of diabetic tractional retinal detachment (TRD) of various severities. Methods: This retrospective case series examined the outcomes of 27-gauge PPV to repair diabetic TRD from 2016 to 2020. The effect of medical and ophthalmologic history parameters and baseline detachment characteristics on visual acuity (VA) and retinal reattachment was analyzed. A grading system was established to stage the severity of the baseline vitreoretinal traction or detachment and compare the visual and anatomic outcomes between stages. Results: The study comprised 79 eyes (79 patients). The overall redetachment rate was 10.1% (8/79). The proportion of eyes with severe visual impairment (worse than 20/200) decreased from 81.0% (64/79) preoperatively to 56.9% (37/65) 6 months postoperatively (P < .001). Worse preoperative logMAR VA was associated with greater odds of redetachment (P = .017) and worse postoperative VA (P < .001). Insulin dependence was associated with better VA at 6 months (P = .017). A shorter known duration of diabetes (P = .026) and evidence of neovascularization of the iris (NVI) or angle (P = .004) were associated with worse visual outcomes. Eyes with detachment involving the posterior pole extending beyond the equator had worse VA at 6 months (P = .048). Conclusions: The primary reattachment rate after 27-gauge PPV was 89.9%. There was significant VA improvement, with a roughly 40% reduction in the number of eyes with severe visual impairment by the final follow-up. Insulin dependence, duration of diabetes, presence of NVI before surgery, and baseline posterior pole detachment extending beyond the equator were predictors of visual outcomes.
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Affiliation(s)
- Ryan T. Duong
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Xiaoyu Cai
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Naveen R. Ambati
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
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Zhao M, Chandra A, Xu J, Li J. Factors related to postoperative vitreous hemorrhage after small-gauge vitrectomy in proliferative diabetic retinopathy patients. BMC Ophthalmol 2023; 23:215. [PMID: 37189104 DOI: 10.1186/s12886-023-02940-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/23/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The role of anticoagulation or antiplatelet on post-vitrectomy vitreous hemorrhage (POVH) in patients with proliferative diabetic retinopathy (PDR) is rarely investigated in the small-gauge vitrectomy era. We investigate the relationship between the long-term use of those medications and POVH in a group of PDR patients. METHODS A retrospective cohort study was carried out in a group of PDR patients who underwent small-gauge vitrectomy in our center. The baseline data on diabetes, diabetic complications, long-term use of anticoagulants and antiplatelet agents, ocular findings, and vitrectomy details were collected. The occurrence of POVH was recorded during at least three-month follow-up. Factors related to POVH were analyzed using logistic analysis. RESULTS During a median follow-up of 16 weeks, 5% (11/220) of patients had POVH, and 75 had received antiplatelet or anticoagulation agents before the operation. Factors related to persistent POVH were the use of antiplatelet or anticoagulation agents (5.98, 1.75-20.45, p = 0.004), the presence of myocardial revascularization (130.65, 3.53-4834.50, p = 0.008), the presence of coronary artery disease (CAD) treated with medicine (56.52, 1.99-1604.06, p = 0.018), and younger age (0.86, 0.77-0.96, p = 0.012). For those receiving preoperative antiplatelet or anticoagulation agents, the probability of developing POVH was higher in the patients whose previous therapy was adjusted compared to those with continued therapy (p = 0.02 by Log-rank test). CONCLUSIONS We identified long-term use of anticoagulation or antiplatelet medication, the presence of CAD, and younger age as three independent factors related to POVH. In PDR patients on long-term antiplatelet or anticoagulation medications, particular attention should be given to controlling intraoperative bleeding, and follow-up for POVH should be scheduled.
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Affiliation(s)
- Meng Zhao
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China
| | - Aman Chandra
- Mid & South Essex NHS Foundation Trust (Southend University Hospital) Prittlewell Chase Essex SS00RY, Anglia Ruskin University, Cambridge, UK
| | - Jun Xu
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China
| | - Jipeng Li
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China.
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Nanegrungsunk O, Patikulsila D, Sadda SR. Ophthalmic imaging in diabetic retinopathy: A review. Clin Exp Ophthalmol 2022; 50:1082-1096. [PMID: 36102668 PMCID: PMC10088017 DOI: 10.1111/ceo.14170] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
Retinal imaging has been a key tool in the diagnosis, evaluation, management and documentation of diabetic retinopathy (DR) and diabetic macular oedema (DMO) for many decades. Imaging technologies have rapidly evolved over the last few decades, yielding images with higher resolution and contrast with less time, effort and invasiveness. While many retinal imaging technologies provide detailed insight into retinal structure such as colour reflectance photography and optical coherence tomography (OCT), others such as fluorescein or OCT angiography and oximetry provide dynamic and functional information. Many other novel imaging technologies are in development and are poised to further enhance our evaluation of patients with DR.
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Affiliation(s)
- Onnisa Nanegrungsunk
- Doheny Imaging Reading Center Doheny Eye Institute Pasadena California USA
- David Geffen School of Medicine University of California‐Los Angeles Los Angeles California USA
- Retina Division, Department of Ophthalmology Chiang Mai University Chiang Mai Thailand
| | - Direk Patikulsila
- Retina Division, Department of Ophthalmology Chiang Mai University Chiang Mai Thailand
| | - Srinivas R. Sadda
- Doheny Imaging Reading Center Doheny Eye Institute Pasadena California USA
- David Geffen School of Medicine University of California‐Los Angeles Los Angeles California USA
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Kang YK, Shin JP. Clinical Analysis of Persistent Subretinal Fluid after Pars Plana Vitrectomy in Macula with Diabetic Tractional Retinal Detachment. J Clin Med 2021; 10:jcm10245929. [PMID: 34945225 PMCID: PMC8709087 DOI: 10.3390/jcm10245929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/29/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: We analyzed the duration of persistent subretinal fluid (PSF) and the contributing factors of PSF after pars plana vitrectomy in patients who had a macula with diabetic tractional retinal detachment (TRD). (2) Methods: Forty eyes of 40 patients who had pars plana vitrectomy due to a macula with diabetic TRD, between 2014 and 2020, were retrospectively reviewed. The duration of PSF, as well as relevant ocular and systemic factors, was analyzed. (3) Results: The mean duration of PSF was 4.4 ± 4.7 months. The prevalence of PSF was 75.0% at 1 month, 50.0% at 3 months, 30.0% at 6 months and 10.0% at 12 months after surgery. Blood urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR) were significantly associated with the duration of PSF in the univariate analysis. In the multivariate analysis, only eGFR was significantly associated with the duration of PSF (β = -0.089, p = 0.030). (4) Conclusion: PSF may persist for more than 12 months in a macula with diabetic TRD after vitrectomy. Moreover, patients with impaired kidney function tended to have a delayed subretinal fluid absorption. Therefore, careful investigation of preoperative systemic conditions, especially kidney function, should be considered before TRD surgery in diabetic patients.
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Crabtree GS, Chang JS. Management of Complications and Vision Loss from Proliferative Diabetic Retinopathy. Curr Diab Rep 2021; 21:33. [PMID: 34477996 DOI: 10.1007/s11892-021-01396-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Diabetes can be associated with profound visual loss due to several mechanisms. As the duration of diabetes and blood glucose levels increase, these changes become more severe. The proliferation of new blood vessels, vitreous hemorrhage, and tractional retinal detachments may ultimately result and can be devastating to visual function. New advances, including anti-vascular endothelial growth factor (VEGF) medications and innovative microsurgical instruments, have provided additional methods for the management of diabetic retinopathy in the clinic and in the operating room, leading to improved outcomes. RECENT FINDINGS Advances in earlier treatment of proliferative diabetic retinopathy, especially with anti-VEGF injections, allow for a reduction in severity, improved vision, and more controlled and successful surgery. Modern surgical techniques and instrumentation have also allowed for improved patient outcomes. Future research into sustained delivery and release of anti-VEGF, reducing the need for frequent in-office injections, may prove to be additionally beneficial. Over the last decade, anti-VEGF has become an increasingly common treatment modality for the management of proliferative diabetic retinopathy, vitreous hemorrhages, and tractional retinal detachments. Further research is needed to determine the ideal method of delivery and timing of the treatment.
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Affiliation(s)
- Gordon S Crabtree
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave, Suite 206, Madison, WI, 53705, USA
| | - Jonathan S Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave, Suite 206, Madison, WI, 53705, USA.
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Abu-Ameerh M, Alni'mat A, AlShawabkeh M, AlRyalat SA. Vision-Related Quality of Life After Vitrectomy: Cross-Sectional Study from Jordan. Clin Ophthalmol 2021; 15:1831-1838. [PMID: 33976531 PMCID: PMC8106465 DOI: 10.2147/opth.s297896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background In the era of patient-centered medical care, using objective clinical measures to assess patient-centered outcomes in all aspects became a necessity, and pars plana vitrectomy (PPV) is a major ophthalmic surgical procedure used for the treatment of vitreoretinal disorders aiming to improve their vision-related quality of life. Purpose To study the impact of PPV on visual quality of life by assessing its effect on common daily activities, to assess its association with various factors, and to explore the relations between these factors and postoperative visual function. Methods Vision-related quality of life for 87 patients who underwent PPV was assessed using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) by phone call interviews. Variables assessed include age, gender, indication of surgery, duration since surgery, preoperative best-corrected visual acuity (BCVA), postoperative BCVA, fellow eye BCVA, medical history and lens status. Results The factors significantly affecting the total score were postoperative visual acuity and fellow eye VA. Upon analyzing the effect of the indication on total score, a significant difference was found with the highest being for those who had dropped lens as the indication for surgery and the lowest was for those with tractional retinal detachment (TRDs) and inflammatory indications. Subscale analysis and visual acuity improvement were also varying between indications. Conclusion VRQOL significantly improves after PPV, the improvement is variable with different indications, being the greatest for those with dropped lens and the least for TRDs and endophthalmitis, with postoperative VA being the most important factor affecting the VRQOL score.
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Affiliation(s)
- Mohammed Abu-Ameerh
- Ophthalmology Department, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Ayat Alni'mat
- Ophthalmology Department, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Mo'ath AlShawabkeh
- Ophthalmology Department, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Saif Aldeen AlRyalat
- Ophthalmology Department, Jordan University Hospital, University of Jordan, Amman, Jordan
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Al-Khersan H, Venincasa MJ, Kloosterboer A, Sridhar J, Smiddy WE, Townsend JH, Flynn HW. Pars Plana Vitrectomy Reoperations for Complications of Proliferative Diabetic Retinopathy. Clin Ophthalmol 2020; 14:1559-1563. [PMID: 32606570 PMCID: PMC7293964 DOI: 10.2147/opth.s252285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To report visual acuity in patients undergoing pars plana vitrectomy (PPV) reoperations for complications of proliferative diabetic retinopathy (PDR). Design Retrospective case series. Subjects Diabetic patients undergoing reoperation with PPV between 2015 and 2018 at a university referral center. Methods Patient charts were reviewed for indication for initial and repeat PPV, baseline clinical characteristics including gender, age, and lens status, and pre- and post-operative best-corrected visual acuity. Main Outcome Measures Best-corrected visual acuity at last follow-up. Results Of 538 eyes (409 patients) undergoing a PPV for diabetic retinopathy, 153 (28.4%) eyes had reoperation. Among the 130 eyes (119 patients) that met the inclusion criteria, 55 eyes (50 patients) underwent reoperation for complications of PDR, defined as non-clearing vitreous hemorrhage (NCVH) and/or tractional retinal detachment (TRD). Within this subgroup of 55 eyes, 19 (34.5%) eyes had an indication for the first surgery of NCVH. Fourteen (73.7%) of these NCVH eyes achieved a visual acuity of 20/80 or better. When the indication for the first surgery was TRD (33 eyes, 60%), 8 (24.2%) eyes achieved this same outcome (p=0.0011). Conclusion Approximately one of every four eyes treated with PPV for PDR will undergo repeat PPV during follow-up. VA outcomes after the repeat PPV were variable, with NCVH cases achieving better outcomes compared to TRD.
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Affiliation(s)
- Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael J Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amy Kloosterboer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Outcomes of vitrectomy for diabetic tractional retinal detachment in Chicago's county health system. PLoS One 2019; 14:e0220726. [PMID: 31430299 PMCID: PMC6701761 DOI: 10.1371/journal.pone.0220726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/22/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine outcomes of 23-gauge (23G) pars plana vitrectomy (PPV) for complex diabetic tractional retinal detachment (TRD) in Chicago's Cook County Health and Hospitals System (CCHHS). MATERIALS AND METHODS This is a retrospective noncomparative study of diabetic TRD cases that underwent PPV at CCHHS. Primary retinal reattachment rate, visual function, and postoperative complications were analyzed. RESULTS Sixty nine consecutive cases were included. Primary reattachment and final attachment were achieved in 68/69 eyes (98.6%). Secondary retinal detachment was noted in 1 eye (1.4%). Vitreous hemorrhage requiring repeat PPV developed in 5 eyes (7.2%) and reoperation due to other complications was required in 4/69 eyes (5.8%). Perfluoropropane (C3F8) gas tamponade was used in 91.3% of eyes and silicone oil in 8.7% of eyes. Mean LogMAR visual acuity significantly improved from 1.84 ± 0.61 to 0.93 ± 0.66, (P<0.0001). Vision was stabilized or improved in 66 eyes (95.7%). Visual acuity of 20/200 or better was achieved in 49/69 eyes (71.0%) and 20/50 or better in 16/69 eyes (23.2%). CONCLUSIONS Even in patients with severe and advanced diabetic TRD pathology and unique demographics as seen in CCHHS, modern vitrectomy techniques can provide excellent anatomical and visual outcomes.
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VISUAL AND ANATOMICAL OUTCOMES AFTER DIABETIC TRACTION AND TRACTION-RHEGMATOGENOUS RETINAL DETACHMENT REPAIR. Retina 2019; 38:1913-1919. [PMID: 28796149 DOI: 10.1097/iae.0000000000001793] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate visual and anatomical outcomes of diabetic tractional retinal detachment repaired with pars plana vitrectomy. METHODS Operative records were used to retrospectively identify all patients with tractional retinal detachments secondary to proliferative diabetic retinopathy surgically repaired with pars plana vitrectomy between November 1, 2009, and January 1, 2015 at the LAC + USC (Los Angeles County + University of Southern California) Medical Center. RESULTS A total of 403 eyes with diabetic tractional retinal detachment in 359 patients were included. Successful reattachment of the retina was achieved in 87.6% of eyes after one surgery and 92.6% of eyes at the final follow-up. Best-corrected visual acuity at the final follow-up improved two or more lines in 56.3% of eyes, was stable in 23.8% of eyes, and decreased two or more lines in 19.9% of eyes. Eyes repaired with 23-gauge and 25-gauge vitrectomy systems had similar success rates as eyes treated with 20-gauge instrumentation (P = 0.73). Eyes receiving silicone oil tamponade had lower single-surgery reattachment rates (77.6% vs. 87.6%; P = 0.013), lower reattachment rates at the final follow-up (85.7% vs. 92.6%; P = 0.048), and higher rates of vision loss (34.7% vs. 19.9%; P < 0.0001) but were more likely to have concurrent rhegmatogenous detachment (47.0% vs. 21.3%; P < 0.0001) and macula involving detachment (74.5% vs. 60.0%; P < 0.0001). CONCLUSION In this large, single-center retrospective study of patients with advanced diabetic tractional retinal detachment, vitrectomy achieved excellent anatomical outcome and improved or stabilized vision in 80.1% of eyes. Smaller gauge vitrectomy systems were found to have similar outcomes to 20-gauge instrumentation.
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Iyer SSR, Regan KA, Burnham JM, Chen CJ. Surgical management of diabetic tractional retinal detachments. Surv Ophthalmol 2019; 64:780-809. [PMID: 31077688 DOI: 10.1016/j.survophthal.2019.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/24/2019] [Accepted: 04/30/2019] [Indexed: 01/06/2023]
Abstract
Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. We review the literature related to the management of this disease. Preoperative planning includes appropriate patient selection, diagnostic and prognostic imaging, and medical optimization with reduction of systemic risk factors. Use of antivascular endothelial growth factor for preoperative treatment has had significant benefits for tractional retinal detachment repair in improving surgical efficiency and outcomes. Advances in microsurgical instrumentation are discussed, with attention to small-gauge vitrectomy with improved flow dynamics, viewing strategies, and lighting allowing bimanual surgery. Special emphasis is placed on bimanual surgical technique, choice of tamponade, and the avoidance of iatrogenic damage. Complications and special considerations are further explored. Based on our compilation of relevant literature, we propose a surgical algorithm for the management of these complex patients.
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Affiliation(s)
- Siva S R Iyer
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.
| | - Kathleen A Regan
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Ching J Chen
- Department of Ophthalmology, University of Mississippi School of Medicine, Jackson, Mississippi, USA
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Stewart MW, Browning DJ, Landers MB. Current management of diabetic tractional retinal detachments. Indian J Ophthalmol 2019; 66:1751-1762. [PMID: 30451175 PMCID: PMC6256889 DOI: 10.4103/ijo.ijo_1217_18] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Twenty-five percent of diabetes-related vision loss stems from complications of proliferative diabetic retinopathy (PDR). Panretinal photocoagulation has been the preferred treatment of high-risk PDR for decades and more recently intravitreal injections of drugs that inhibit the actions of vascular endothelial growth factor have become popular. But despite these treatments PDR may progress uncontrollably to advanced pathologies such as traction retinal detachments (TRDs), combined traction/rhegmatogenous retinal detachments (TRD/RRDs), vitreous hemorrhages, rubeosis iridis, and traction maculopathies, which produce mild-to-severe loss of vision. TDR have long been the most common indication for PDR-related vitreoretinal surgery. Vitrectomy surgery is indicated for recent (<6 months duration) TRD involving the macula, progressive TRD that threatens the macula, and recent data suggest that chronic macula-involving TRDs (>6 months duration) may also benefit. Combined TRD/RRD represents a particularly challenging surgical condition but advances in surgical instrumentation, dissection techniques, and post-operative tamponade have produced excellent success rates. The recent development of small-gauge vitrectomy systems has persuaded most surgeons to switch platforms since these appear to produce shorter surgical times and quicker post-operative recoveries. Pre-operative injections of bevacizumab are frequently administered for persistent neovascularization to facilitate surgical dissection of pre-retinal fibrosis and reduce the incidence of post-operative hemorrhages. Recent trends toward earlier surgical intervention and expanded indications are likely to continue as surgical instrumentation and techniques are further developed.
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Affiliation(s)
| | - David J Browning
- Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC, USA
| | - Maurice B Landers
- Department of Ophthalmology, Kittner Eye Center, University of North Carolina, Chapel Hill, NC, USA
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Jain S, Agarwal A, Aggarwal K, Gupta V. The Role of Proportional Reflux During Pars Plana Vitrectomy for Tractional Retinal Detachments. Ophthalmic Surg Lasers Imaging Retina 2019; 50:113-115. [PMID: 30768219 DOI: 10.3928/23258160-20190129-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To discuss the role of proportional reflux hydrodissection (PRH) during pars plana vitrectomy (PPV) in eyes with diabetic tractional retinal detachment (TRD). PATIENTS AND METHODS In this retrospective study, records of patients with diabetic TRD involving the fovea undergoing PPV with the help of PRH between January 2015 to March 2017 were noted. PRH relies on the Constellation system's proportional reflux feature. The mean age, gender, and pre- and postoperative best-corrected visual acuity (BCVA) were noted. Minimum follow-up period of 3 months was ascertained. RESULTS Thirty-three patients were included. Preoperative and postoperative BCVA were 1.80 logMAR units and 1.20 logMAR units, respectively. Fifteen patients also received preoperative intravitreal ranibizumab. Twelve percent needed the help of a second instrument. Thirty-three percent developed intraoperative iatrogenic breaks, and 39.39% needed oil/gas tamponade. All patients had successful reattachments at 3-month follow-up. CONCLUSIONS PRH is simple, cost-effective, surgeon-friendly, and highly controlled technique helpful in managing diabetic TRD. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:113-115.].
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Yadarola MB, Gramajo AL, Arrambide MP, Colombres GA, Juárez CP, Luna JD. Perfluorocarbon Liquid Vitreous Delamination and Wide-Angle Viewing System in the Management of Complicated Diabetic Retinal Detachment. Eur J Ophthalmol 2018; 19:452-9. [DOI: 10.1177/112067210901900321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria B. Yadarola
- Departamento de Oftalmología, Centro de Ojos Romagosa-Fundación VER, Córdoba - Argentina
| | - Ana L. Gramajo
- Departamento de Oftalmología, Centro de Ojos Romagosa-Fundación VER, Córdoba - Argentina
| | - Maria P. Arrambide
- Departamento de Oftalmología, Centro de Ojos Romagosa-Fundación VER, Córdoba - Argentina
| | - Gustavo A. Colombres
- Departamento de Oftalmología, Centro de Ojos Romagosa-Fundación VER, Córdoba - Argentina
| | - Claudio P. Juárez
- Departamento de Oftalmología, Centro de Ojos Romagosa-Fundación VER, Córdoba - Argentina
| | - José D. Luna
- Departamento de Oftalmología, Centro de Ojos Romagosa-Fundación VER, Córdoba - Argentina
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Hooper P, Boucher MC, Cruess A, Dawson KG, Delpero W, Greve M, Kozousek V, Lam WC, Maberley DAL. Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol 2017; 52 Suppl 1:S45-S74. [PMID: 29074014 DOI: 10.1016/j.jcjo.2017.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Philip Hooper
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)..
| | - Marie Carole Boucher
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Alan Cruess
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Keith G Dawson
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Walter Delpero
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Mark Greve
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Vladimir Kozousek
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - Wai-Ching Lam
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
| | - David A L Maberley
- Philip Hooper, London, ON (Chair) (retina and uveitis); Marie Carole Boucher, Montreal, QC (retina and teleophthalmology); Alan Cruess, Halifax, NS (retina); Keith G. Dawson, Vancouver, BC (endocrinology); Walter Delpero, Ottawa, ON (cataract and strabismus); Mark Greve, Edmonton, AB (retina and teleophthalmology); Vladimir Kozousek, Halifax, NS (medical retina); Wai-Ching Lam, Toronto, ON (retina and research); David A.L. Maberley, Vancouver, BC (retina)
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Yau GL, Silva PS, Arrigg PG, Sun JK. Postoperative Complications of Pars Plana Vitrectomy for Diabetic Retinal Disease. Semin Ophthalmol 2017; 33:126-133. [PMID: 29215958 DOI: 10.1080/08820538.2017.1353832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Despite recent advances in the medical management of diabetic retinal disease, there remain established indications for vitreoretinal surgery in the treatment of severe proliferative diabetic retinopathy. These include non-clearing vitreous hemorrhage and tractional retinal detachment. Advances in surgical instrumentation, technique, and experience have led to improved visual outcomes, as well as a corresponding decrease in the incidence of postoperative complications. However, the presence of systemic and ocular factors in diabetic patients increases the risk of adverse events compared to non-diabetic individuals. This review will focus on the most important postoperative complications following pars plana vitrectomy, with specific considerations for the diabetic patient.
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Affiliation(s)
- Gary L Yau
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA
| | - Paolo S Silva
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Paul G Arrigg
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Jennifer K Sun
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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16
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Abunajma MA, Al-Dhibi H, Abboud EB, Al Zahrani Y, Alharthi E, Alkharashi A, Ghazi NG. The outcomes and prognostic factors of vitrectomy in chronic diabetic traction macular detachment. Clin Ophthalmol 2016; 10:1653-61. [PMID: 27616879 PMCID: PMC5008643 DOI: 10.2147/opth.s98555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose To investigate the outcomes of pars plana vitrectomy (PPV) for chronic diabetic traction macular detachment (CTMD). Methods Ninety-six eyes that underwent PPV for CTMD of at least 6 months duration were retrospectively analyzed. Retinal reattachment rate, final vision, and prognostic factors for poor visual outcome were the main outcome measures. Results All eyes had long-standing TMD (median 12, range: 6–70 months). The median postoperative follow-up was 15 (range: 3–65) months. Eighty-seven eyes (90.6%) had their retina and macula reattached after one PPV. At final examination, 84 eyes (87.5%) had stable vision or at least one line improvement, and three had no light perception. Seventeen (17.7%) and 41 (43%) eyes had preoperative visual acuity of ≥20/200 and ≥5/200 as compared to 40 (41.6%; P=0.0005) and 64 (66.7%; P=0.0014) eyes at final follow-up, respectively. Age >50 years (Odds ratio [OR] =5.84, 95% confidence interval [CI] =1.53–22.19, P=0.01), preoperative vision <20/400 (OR =7.012, 95% CI =1.82–26.93, P=0.005), and ischemic macula (OR =14.13, 95% CI =3.61–55.33, P<0.001) were significantly associated with final vision <20/400. Conclusion PPV for CTMD may be beneficial particularly in patients who are relatively younger and have good baseline vision and no macular ischemia.
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Affiliation(s)
- Muneera A Abunajma
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hassan Al-Dhibi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Emad B Abboud
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Yahya Al Zahrani
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Abdullah Alkharashi
- Department of Ophthalmology, College of Medicine, King Saud University Riyadh, Saudi Arabia
| | - Nicola G Ghazi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
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Khatib N, Carvounis PE. Surgical Management of Tractional Retinal Detachments in Proliferative Diabetic Retinopathy. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Abstract
Over the recent years, retina specialists have enjoyed significant improvements in the surgical management of proliferative diabetic retinopathy including improved preoperative planning, vitreoretinal instrumentation and new surgical maneuvers. In this review, we present new tips and tricks such as preoperative pharmacotherapy approaches including pegaptanib injection and biodegradable dexamethasone implantation, bimanual vitrectomy techniques and the concept of mixing small gauges as well as valved cannulas and intraoperative optical coherence tomography. With advanced surgical planning and sophisticated operative maneuvers tailored to the individual patient, excellent outcomes can be achieved even in severe cases of diabetic tractional detachment.
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Affiliation(s)
- Patrick Oellers
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Tamer H Mahmoud
- Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
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19
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Sharma T, Fong A, Lai TY, Lee V, Das S, Lam D. Surgical treatment for diabetic vitreoretinal diseases: a review. Clin Exp Ophthalmol 2016; 44:340-54. [PMID: 27027299 DOI: 10.1111/ceo.12752] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 01/26/2023]
Abstract
Over the past four decades, advancements in surgical instrumentations and techniques have significantly improved the postoperative anatomical and visual outcomes of patients with various diabetic vitreoretinal diseases. In particular, surgical interventions for previously serious and untreatable blinding proliferative diabetic retinopathy can now be performed, with much better results. The advents of micro incisional vitrectomy system with better visualization system like binocular indirect ophthalmomicroscope and state-of-the-art instrumentation revolutionized the era of diabetic vitrectomy. High-speed vitrectors, finer instruments, chromo-assisted vitrectomy and use of anti-vascular endothelial growth factors not only change the paradigm but also help achieve much better outcome after diabetic vitrectomies. In this review, we will discuss and summarize the indications, surgical considerations, surgical techniques, potential complications and outcomes of vitreoretinal surgery for diabetic eye diseases.
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Affiliation(s)
- Tarun Sharma
- Sankara Nethralaya (Main Campus), Chennai, Tamil Nadu, India
| | - Angie Fong
- Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Timothy Y Lai
- 2010 Eye & Cataract Centre, TsimShaTsui, Kowloon, Hong Kong
| | - Vincent Lee
- Dennis Lam & Partners Eye Center, Central, Hong Kong
| | - Sudipta Das
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China
| | - Dennis Lam
- Dennis Lam & Partners Eye Center, Central, Hong Kong.,C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China
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20
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Abstract
PURPOSE To investigate anatomical and functional outcomes of vitreoretinal fellow-performed vitrectomy for tractional retinal detachment secondary to proliferative diabetic retinopathy in a county hospital system. METHODS Consecutive retrospective review of patients surgically treated for diabetic tractional retinal detachment at Olive View-UCLA County Medical Center (Sylmar, CA) during a 2-year training period. RESULTS Sixty-two eyes of 58 patients met inclusion criteria with a mean age of 48 ± 9 years and preoperative hemoglobin A1c of 8.4 ± 1.9%. Previous panretinal photocoagulation had been performed in 34 eyes (54.8%). Mean surgery duration was 153 ± 54 minutes. There was no significant time difference observed between first-year fellow surgeries (159.5 ± 52.3 minutes) and those performed by second-year fellows (146.8 ± 56.4 minutes, P = 0.35), although there was a trend toward longer first-year surgical times. After a mean follow-up of 11.2 months, successful retinal reattachment was achieved in 56 eyes (90.3%). Overall, mean logMAR visual acuity improved from 2.0 ± 0.5 to 1.4 ± 0.8 (P = 0.0007). Final visual acuity had improved in 33 eyes (53.2%), was unchanged in 11 eyes (17.7%), and decreased in 18 eyes (29%). Postoperative complications encountered included early vitreous hemorrhage in 10 eyes (16.1%), delayed vitreous hemorrhage in 3 eyes (4.8%), secondary rhegmatogenous retinal detachment in 11 eyes (17.7%), and neovascular glaucoma in 5 eyes (8%). Second-year fellows had a lower incidence of rhegmatogenous retinal detachment than first-year fellows (P = 0.016). CONCLUSION Patients with diabetic tractional retinal detachment present to county hospitals with more complex retinal pathology, yet surgical outcomes as performed by vitreoretinal fellows compare favorably to previously reported series.
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21
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Sharma S, Hariprasad SM, Mahmoud TH. Surgical management of proliferative diabetic retinopathy. Ophthalmic Surg Lasers Imaging Retina 2014; 45:188-93. [PMID: 24840530 DOI: 10.3928/23258160-20140505-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Qamar RMR, Saleem MI, Saleem MF. The outcomes of pars plana vitrectomy without endotamponade for tractional retinal detachment secondary to proliferative diabetic retinopathy. Int J Ophthalmol 2013; 6:671-4. [PMID: 24195047 DOI: 10.3980/j.issn.2222-3959.2013.05.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 07/24/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the outcomes of pars plana vitrectomy (PPV) without the use of an ocular tamponade in patients having tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). METHODS It was an interventional study conducted at the Department of Ophthalmology, B.V. Hospital, Bahawalpur, Pakistan, from July 2011 to July 2012. A total of 75 patients (84 eyes) having TRD secondary to PDR were treated by PPV without using an ocular tamponade. All patients included in the study had a tractional retinal detachment secondary to proliferative diabetic retinopathy but didn't have or develop retinal breaks before or during the study period. The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina. The mean follow-up period was 12 months. RESULTS Successful retinal reattachement was observed in 78 of the operated eyes (92.8%). In these patients, the retina remained attached till the end of the one year follow-up period. Improvement in best corrected visual acuity (BCVA) was seen in 63 eyes (75%). The visual acuity remained unchanged in 9 eyes (10.7%). Mean improvement in BCVA was 2.00+1.24 at baseline to 1.24+1.22 (P<0.05) at the end of the follow-up period. CONCLUSION In the absence of the retinal breaks, a TRD secondary to PDR can be successfully treated by pars plana vitrectomy without the use of an ocular tamponade.
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23
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Bandello F, Lattanzio R, Zucchiatti I, Del Turco C. Pathophysiology and treatment of diabetic retinopathy. Acta Diabetol 2013; 50:1-20. [PMID: 23277338 DOI: 10.1007/s00592-012-0449-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 12/11/2012] [Indexed: 01/07/2023]
Abstract
In the past years, the management of diabetic retinopathy (DR) relied primarily on a good systemic control of diabetes mellitus, and as soon as the severity of the vascular lesions required further treatment, laser photocoagulation or vitreoretinal surgery was done to the patient. Currently, even if the intensive metabolic control is still mandatory, a variety of different clinical strategies could be offered to the patient. The recent advances in understanding the complex pathophysiology of DR allowed the physician to identify many cell types involved in the pathogenesis of DR and thus to develop new treatment approaches. Vasoactive and proinflammatory molecules, such as vascular endothelial growth factor (VEGF), play a key role in this multifactorial disease. Current properly designed trials, evaluating agents targeting VEGF or other mediators, showed benefits in the management of DR, especially when metabolic control is lacking. Other agents, directing to the processes of vasopermeability and angiogenesis, are under investigations, giving more hope in the future management of this still sight-threatening disease.
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Affiliation(s)
- Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy.
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24
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Brunner S, Binder S. Surgery for Proliferative Diabetic Retinopathy. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Hooper P, Boucher MC, Cruess A, Dawson KG, Delpero W, Greve M, Kozousek V, Lam WC, Maberley DAL. Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy. Can J Ophthalmol 2012; 47:S1-30, S31-54. [PMID: 22632804 DOI: 10.1016/j.jcjo.2011.12.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Smiddy WE. Diabetic vitrectomy is safer and is applicable at an earlier stage of disease. EXPERT REVIEW OF OPHTHALMOLOGY 2012. [DOI: 10.1586/eop.12.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gupta B, Wong R, Sivaprasad S, Williamson TH. Surgical and visual outcome following 20-gauge vitrectomy in proliferative diabetic retinopathy over a 10-year period, evidence for change in practice. Eye (Lond) 2012; 26:576-82. [PMID: 22241020 DOI: 10.1038/eye.2011.348] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The study reports 10-year anatomical and visual outcome in patients who underwent pars plana vitrectomy (PPV) for complications due to proliferative diabetic retinopathy (PDR). METHODS Retrospective analysis of patients undergoing 20 G PPV from January 1999 to May 2010 for tractional retinal detachment (TRD) and non-clearing vitreous hemorrhage (NCVH) secondary to PDR recorded prospectively on an electronic patient record. The primary aim was to study anatomical success and eyes with visual acuity (VA) of ≤ 0.3 logMAR at last follow-up. RESULTS There were 346 eyes of 249 patients with mean age of 55.63 years and follow-up of 1.44 years. In all, 95.3% of eyes had a flat retina at final follow-up. Overall 136/346 (39.4%) eyes had final VA of logMAR ≤ 0.3 (Snellen 6/12) and 129 (37.3%) had logMAR ≥ 1.0 (Snellen 6/60). In all, 50/181 (27.6%) eyes with TRD and 84/165 (50.9%) with NCVH achieved final VA of ≤ 0.3 logMAR (Snellen 6/12). A total of 218 (63.1%) showed ≥ 0.3 logMAR improvement from baseline to last follow-up. Both preoperative VA and final postoperative (post-op) VA (P<0.001) improved significantly with each year from 1999 to 2010. The commonest peroperative complication was iatrogenic retinal tear formation (28.4%). This was a risk factor for the development of post-op retinal detachment, odds ratio: 3.90 (95% confidence interval: 1.91-7.97, P = 0.0002). Silicone oil was used in 5.2% of patients at the primary procedure. In all, 9.2% required removal of non clearing post vitrectomy hemorrhage. CONCLUSIONS Outcomes from vitreoretinal surgery for complications of diabetic retinopathy have improved. In addition, the visual outcome after diabetic vitrectomy steadily improved over the 10-year period, which may in part be due to the move to operate on patients with better vision.
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Affiliation(s)
- B Gupta
- St Thomas' Hospital, London, UK
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28
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Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study. Eye (Lond) 2012; 26:510-6. [PMID: 22222268 DOI: 10.1038/eye.2011.321] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION End-stage diabetic eye disease is an important cause of severe visual impairment in the working-age group. With the increasing availability of refined surgical techniques as well as the early diagnosis of disease because of screening, one would predict that the prevalence of this condition is decreasing and the visual outcome is improving. AIM To study the prevalence and visual outcome following vitrectomy for complications of diabetic retinopathy. MATERIALS AND METHODS This study identified the patients who underwent vitrectomy from January 2007 to December 2009 because of diabetes-related complications in South East London. Data collected included baseline demographics, best-corrected visual acuity, indication for the vitrectomy, complication, outcome, and duration of follow-up. RESULTS The prevalence of people requiring vitrectomy who are registered in the diabetes register of this region was 2 per 1000 people with diabetes. Vitrectomy was required in 185 eyes of 158 patients during this period. These included 83 Caucasians, 51 Afro-Caribbeans, 17 South Asians, and 7 from other ethnic groups. There were 58 patients with type I diabetes and 100 with type II, with a mean duration of diabetes of 23 and 16.5 years, respectively. The reason for vitrectomy included tractional retinal detachment (TRD) in 109 eyes, non-clearing vitreous haemorrhage (NCVH) in 68 eyes, and other causes in 8 eyes. In all, 50% of the eyes with TRD and NCVH, and 87% of the eyes with NCVH improved by at least three ETDRS lines at 12 months. Poor predictors of visual success included longer duration of diabetes (OR: 0.69), use of insulin (OR: 0.04), presence of ischaemic heart disease (OR: 0.04), delay in surgery (OR: 0.59), and the failure to attend clinic appointments (OR: 0.58). Preoperative use of intravitreal bevacizumab in eyes with TRD undergoing vitrectomy showed a marginal beneficial effect on co-existent maculopathy (P=0.08) and required less laser intervention post procedure, but did not affect the number of episodes of late-onset vitreous haemorrhage post vitrectomy (P=0.81). CONCLUSION Visual outcome has improved significantly in eyes with complications due to diabetic retinopathy compared with the previously reported Diabetic Vitrectomy Study.
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Velez-Montoya R, Guerrero-Naranjo JL, Garcia-Aguirre G, Morales-Cantón V, Fromow-Guerra J, Quiroz-Mercado H. Perfluorocarbon-perfused 23 gauge three-dimensional vitrectomy for complicated diabetic tractional retinal detachment. Clin Ophthalmol 2011; 5:1709-15. [PMID: 22267907 PMCID: PMC3258082 DOI: 10.2147/opth.s26838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Perfluorocarbon liquid (PCL)-perfused vitrectomy has been shown in previous studies to be feasible, safe, and to have advantages in managing complicated cases of tractional retinal detachment. The present study had the objectives of describing the anatomical results and measuring surgical time and PCL consumption when combining PCL-perfused techniques with modern vitrectomy equipment. Methods A prospective, interventional consecutive case series was investigated. We enrolled patients with diabetic tractional retinal detachment, complicated by proliferative vitreoretinopathy and poor vision. A 23 gauge PCL-perfused vitrectomy was done with three-dimensional settings. During the procedure, we assessed the degree of surgical bleeding, visualization quality, and difficulty of membrane dissections. Visual acuity, intraocular pressure, and anatomical success were assessed at one and 3 months of follow-up. Results Twelve patients were enrolled in this study. There were no statistical significant changes in intraocular pressure and visual acuity throughout the follow-up period. Surgery was performed in a hemorrhage-free environment in almost all cases, with good visualization and low technical difficulty. The mean complete surgical time was 94.92 ± 25.03 minutes. The mean effective vitrectomy time was 22.50 ± 19.04 minutes and the mean PCL consumption was 25.08 ± 9.76 mL, with a speed of 1.11 mL/minute. Anatomical success was 67% at 3 months. Conclusion Although the technique proved to have some advantages in managing complicated cases of diabetic tractional retinal detachment, there was a high consumption of PCL. A redesign of the entire system is needed in order to decrease the amount of PCL needed for the technique.
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Affiliation(s)
- Raul Velez-Montoya
- Department of Ophthalmology, University of Colorado Health and Science Center, Rocky Mountain Lions Eye Institute, University of Colorado School of Medicine, CO, USA
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Long-term results of vitrectomy without endotamponade in proliferative diabetic retinopathy with tractional retinal detachment. Retina 2010; 30:447-51. [PMID: 20216292 DOI: 10.1097/iae.0b013e3181d374a5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with proliferative diabetic retinopathy and tractional retinal detachment. METHODS A clinical interventional case-series study was conducted of 168 eyes of 150 patients with diabetic tractional retinal detachment who were consecutively treated by pars plana vitrectomy without endotamponade during a study period of 7 years. Per selection criterion, retinal defects did not develop or were not observed in any of the study participants before or during surgery. The surgery included pars plana vitrectomy, removal of epiretinal membranes, and retinal endolaser coagulation. Combined cataract surgery was performed in 33 eyes (20%). The mean follow-up was 23 + or - 14 months (range, 12-65 months). RESULTS In 158 eyes (94%), the retina reattached after surgery and remained attached until the end of follow-up. Subretinal fluid absorbed completely within 2 months after surgery. Best-corrected visual acuity improved in 126 eyes (75%) and remained unchanged in 19 eyes (11%). Mean best-corrected visual acuity improved from 2.22 + or - 1.22 at baseline to 1.24 + or - 1.00 at final follow-up (P < 0.001). At the end of follow-up, 11 eyes (7%) showed iris neovascularization, and 9 of these 11 eyes developed iris neovascularization after surgery. In multivariate logistic regression, the only factor associated with postoperative rubeosis iridis was preexisting rubeosis iridis (odds ratio, 6.4). CONCLUSION Vitreoretinal surgery for tractional retinal detachment in proliferative diabetic retinopathy may not necessarily be combined with an ocular endotamponade if there were no pre- or intraoperative retinal breaks.
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31
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Newman DK. Surgical management of the late complications of proliferative diabetic retinopathy. Eye (Lond) 2010; 24:441-9. [DOI: 10.1038/eye.2009.325] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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D'amico DJ. Diabetic Traction Retinal Detachments Threatening the Fovea and Panretinal Argon Laser Photocoagulation. Semin Ophthalmol 2009. [DOI: 10.3109/08820539109060176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Oshima Y, Shima C, Wakabayashi T, Kusaka S, Shiraga F, Ohji M, Tano Y. Microincision Vitrectomy Surgery and Intravitreal Bevacizumab as a Surgical Adjunct to Treat Diabetic Traction Retinal Detachment. Ophthalmology 2009; 116:927-38. [DOI: 10.1016/j.ophtha.2008.11.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 11/04/2008] [Accepted: 11/04/2008] [Indexed: 10/21/2022] Open
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Affiliation(s)
- Dean Eliott
- Doheny Retina Institute, University of Southern California, Keck School of Medicine, 1450 San Pablo Street, Los Angeles, CA 90033, USA
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35
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Goldenberg DT, Hassan TS. Small gauge, sutureless surgery techniques for diabetic vitrectomy. Int Ophthalmol Clin 2009; 49:141-151. [PMID: 19349794 DOI: 10.1097/iio.0b013e31819fd9e0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- David T Goldenberg
- Associated Retinal Consultants, 3535 W. 13 Mile Road, Suite 344, Royal Oak, MI 48073, USA
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Abstract
The field of ophthalmology has undergone revolutionary changes during the past few decades. Advancements in understanding the pathophysiology of eye diseases, superior surgical instrumentation and surgeon skills, and cotreatment with medical therapies have enhanced outcomes. The geriatric population, preferentially affected by these illnesses, has seen a meaningful visual benefit from these surgical innovations. Most importantly, these improvements have led to increases in quality-of-life measures and mental and physical well-being of aging patients.
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Affiliation(s)
- Rishi P Singh
- Cole Eye Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Schrey S, Krepler K, Wedrich A. INCIDENCE OF RHEGMATOGENOUS RETINAL DETACHMENT AFTER VITRECTOMY IN EYES OF DIABETIC PATIENTS. Retina 2006; 26:149-52. [PMID: 16467669 DOI: 10.1097/00006982-200602000-00004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the incidence of rhegmatogenous retinal detachment (RRD) after pars plana vitrectomy (PPV) among diabetic patients with complications of proliferative diabetic retinopathy. METHODS Ninety-three eyes of diabetic patients-who underwent PPV with or without intraocular gas tamponade for complications of proliferative diabetic retinopathy-were reviewed retrospectively. Indication for vitrectomy was vitreous hemorrhage in 80 patients (86.1%), tractional retinal detachment in 3 (3.2%), and vitreous hemorrhage associated with tractional retinal detachment in 10 (10.7%). RESULTS Four (4.3%) of 93 eyes developed an RRD after vitrectomy. The primary reason for vitrectomy was recurrent or nonresolving vitreous hemorrhage. The retina was attached with one additional surgical procedure in two of these eyes; the other two had to undergo a third operation before attachment was achieved. CONCLUSION RRD occurs in a small percentage of patients after PPV with or without gas tamponade for vitreous hemorrhage or tractional retinal detachment caused by proliferative diabetic retinopathy. Thorough postoperative follow-up is important to make early diagnosis and intervention possible.
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Affiliation(s)
- Susanne Schrey
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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Eliott D, Lee MS, Abrams GW. Proliferative Diabetic Retinopathy: Principles and Techniques of Surgical Treatment. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Douglas MJ, Scott IU, Flynn HW. Pars Plana Lensectomy, Pars Plana Vitrectomy, and Silicone Oil Tamponade as Initial Management of Cataract and Combined Traction/Rhegmatogenous Retinal Detachment Involving the Macula Associated With Severe Proliferative Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2003. [DOI: 10.3928/1542-8877-20030701-01] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Imamura Y, Minami M, Ueki M, Satoh B, Ikeda T. Use of perfluorocarbon liquid during vitrectomy for severe proliferative diabetic retinopathy. Br J Ophthalmol 2003; 87:563-6. [PMID: 12714393 PMCID: PMC1771679 DOI: 10.1136/bjo.87.5.563] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the value of using perfluorocarbon liquid (PFCL) during vitrectomy in eyes with proliferative diabetic retinopathy (PDR). METHODS The surgical records of eyes with PDR (291 eyes of 228 patients) that underwent vitrectomy in the vitreoretinal service of Osaka Medical College (April 1999 to October 2001) were reviewed. From these, 18 eyes of 15 patients had PFCL used during vitrectomy, and the preoperative and postoperative findings of these eyes were analysed. RESULTS All of the 18 eyes had advanced PDR with tractional and/or rhegmatogenous retinal detachment. PFCL enabled easier flattening of the retinal folds and effective endophotocoagulation. In two cases, PFCL was used to flatten a bullous retinal detachment that developed when a tight vitreoretinal adhesion was loosened. In two other cases with combined traction/rhegmatogenous retinal detachment, PFCL was used to tamponade the detached retina which then allowed successful membrane dissection. Anatomical success was obtained in 16 of the 18 cases (mean follow up time 13.3 months) with visual acuity of 20/200 or better in nine eyes (50%). CONCLUSIONS PFCL is considered to be a useful adjunct during vitrectomy for the treatment of severe PDR.
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Affiliation(s)
- Y Imamura
- Department of Ophthalmology, Osaka Medical College, Osaka, Japan.
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Steinmetz RL, Grizzard WS, Hammer ME. Vitrectomy for diabetic traction retinal detachment using the multiport illumination system. Ophthalmology 2002; 109:2303-7. [PMID: 12466174 DOI: 10.1016/s0161-6420(02)01291-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To examine the visual and anatomic results of bimanual vitrectomy surgery with the multiport illumination system (MIS) in eyes with advanced diabetic traction retinal detachment. DESIGN Retrospective, noncomparative interventional case series. PARTICIPANTS Sixty-seven consecutive eyes in 62 patients having vitrectomy with the MIS. METHODS During surgery, the vitreous, the posterior hyaloid membrane, and fibrovascular proliferative tissue were removed by using bimanual dissection made possible by the MIS. MAIN OUTCOME MEASURES Retinal reattachment rate, visual function, and postoperative complications were compared with previously published series of vitrectomy for diabetic traction retinal detachment. RESULTS With a minimum of 6 months of follow-up, complete retinal reattachment was achieved in 62 eyes (93%), and macular attachment was achieved in all 67 eyes. Vision was stabilized or improved in 51 eyes (72%), and 5/200 vision was achieved in 47 eyes (70%). No unique complications, such as incision-related retinal tears, occurred. CONCLUSION MIS allows bimanual surgery during vitrectomy for diabetic traction retinal detachment, with good visual and anatomic results.
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Williams JG, Trese MT, Williams GA, Hartzer MK. Autologous plasmin enzyme in the surgical management of diabetic retinopathy. Ophthalmology 2001; 108:1902-5; discussion 1905-6. [PMID: 11581070 DOI: 10.1016/s0161-6420(01)00720-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This is a pilot study to assess the use of autologous plasmin enzyme (APE) as an adjunct to vitreous surgery in eyes with advanced diabetic retinopathy. DESIGN Prospective noncomparative interventional case series. PARTICIPANTS Seven patients with advanced diabetic retinopathy selected at random from our practice population. METHODS Seven eyes were treated with APE as an adjunct to standard vitreous surgery. Six eyes had macular tractional retinal detachments, and one eye had refractory macular edema. Three fellow eyes had standard vitreous surgery performed for macular tractional retinal detachments without APE. All 10 eyes had macular edema and background diabetic retinopathy. MAIN OUTCOME MEASURES The main outcome measures included induction of a posterior vitreous detachment, retinal reattachment, improvement in visual acuity, and resolution of macular edema. RESULTS All seven APE-treated eyes achieved spontaneous or easy removal of the posterior hyaloid including one eye that had vitreoschisis over areas of detached retina. All eyes treated with APE had resolution of intraretinal edema. Retinas of all eyes treated with APE were reattached. The three fellow eyes were treated by vitreous surgery without APE. Two of the three fellow eyes had reattached retinas, but none had resolution of intraretinal edema without further focal photocoagulation treatment. Mean visual acuity improvement was 0.7 logarithm of the minimum angle of resolution (LogMAR) units in APE-treated eyes and 0.1 LogMAR units in eyes without APE. The average follow-up period was 14 months. CONCLUSIONS This pilot study suggests that APE may be beneficial in the surgical management of diabetic retinopathy.
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Affiliation(s)
- J G Williams
- William Beaumont Hospital, Royal Oak, Michigan, USA
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Virata SR, Kylstra JA. Postoperative Complications Following Vitrectomy for Proliferative Diabetic Retinopathy with Sew-On and Noncontact Wide-Angle Viewing Lenses. Ophthalmic Surg Lasers Imaging Retina 2001. [DOI: 10.3928/1542-8877-20010501-04] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wafapoor H, Kertes PJ, Navarro GC, Peyman GA, Meffert S, Ganiban GJ, Vierling S. The adjunctive use of perfluoroperhydrophenanthrene (Vitreon) in diabetic vitrectomy. Int Ophthalmol 1999; 22:89-96. [PMID: 10472768 DOI: 10.1023/a:1006186806062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the utility and efficacy of perfluoroperhydrophenanthrene in the management of retinal detachments secondary to severe proliferative diabetic retinopathy. PATIENTS AND METHODS Forty consecutive patients with proliferative diabetic retinopathy and retinal detachments were entered into the study at nine participating clinical centers. Perfluoroperhydrophenanthrene (Vitreon) was used as an adjunct to pars plana vitrectomy and membranectomy. RESULTS Preoperative diagnoses included combined traction and rhegmatogenous retinal detachments in 23 eyes (57.5%), traction retinal detachments in 13 eyes (32.5%), and recurrent rhegmatogenous retinal detachments in 4 eyes (10). Vitreous hemorrhage was present in 17 eyes (42.5%). Preoperative visual acuity ranged from light perception or hand motion in 28 eyes (70%) to 5/200 or greater in 12 eyes (30%). Vitreon was primarily used to flatten the retina following relaxing retinotomy in 12 eyes (30%), to displace subretinal fluid in a posterior-to-anterior direction without performing a drainage retinotomy in 15 eyes (37.5%), and to manage intraoperative complications such as iatrogenic tears in 8 (20%) and retinal dialysis in 5 eyes (12.5%). The retina flattened intraoperatively in all cases, facilitating administration of laser photocoagulation. Patients were followed for a minimum of six months (mean 13.2 months). At last follow up, the macula remained attached in 37 eyes (92.5%), including 31 (77.5%) in which the retina was totally attached. The retina remained detached in 3 eyes (7.5%). Visual acuity improved postoperatively in 20 patients (50%), was unchanged in 13 patients (32.5%), and worsened in 7 patients (17.5%). CONCLUSIONS Perfluoroperhydrophenanthrene is a useful and effective intraoperative tool for the management of complex retinal detachments secondary to severe proliferative diabetic retinopathy.
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Affiliation(s)
- H Wafapoor
- LSU Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans 70112-2234, USA
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Abstract
According to the Early Treatment Diabetic Retinopathy Study, at least 5% of eyes receiving optimal medical treatment will still have progressive retinopathy that requires laser treatment and pars plana vitrectomy. During the past decade, improvements in instrumentation and surgical techniques have allowed more difficult cases of diabetic retinopathy to be candidates for vitrectomy. However, although the thresholds for performing surgery within established indicated situations have been lowered, only a few additional indications have been established. Although vitrectomy improves the prognosis for a favorable visual outcome, preventive measures, such as improved control of glucose levels and timely application of panretinal photocoagulation, produce better results. The authors review the indications, techniques, and results of vitrectomy in the management of diabetic retinopathy.
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Affiliation(s)
- W E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL, USA
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Meier P, Wiedemann P. Vitrectomy for traction macular detachment in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 1997; 235:569-74. [PMID: 9342607 DOI: 10.1007/bf00947086] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A small number of eyes with proliferative diabetic retinopathy develop massive central fibrovascular membranes characterized by vitreoretinal tractions along the arcades and optic disk and retinal traction lines extending through the macula. The aim of our study was first to present the results of vitrectomy for removal of these central membranes and second to determine the correlation between preoperative parameters and postoperative visual outcome. SUBJECTS AND METHODS We treated 28 eyes with severe central fibrovascular diabetic membranes by a modified bi-manual en bloc excision technique during vitrectomy. Preoperative examination included general status, visual acuity, slit-lamp investigation, binocular funduscopy, ultrasound investigation and visual evoked potentials (VEP). Further, we analyzed intraoperative complications and postoperative anatomic and functional outcomes. RESULTS The retinas of 27 eyes with central traction retinal detachments were reattached by surgery. With a minimum of 6 months' follow-up, the macula remained attached in 24 eyes, while the retinas were completely attached in 22 eyes. Preoperative visual acuity was defective light perception to 0.1; an increase in visual acuity to maximal 0.1 was seen in 50% of the patients postoperatively. Preoperative visual acuity of light perception was associated with no functional improvement. Preoperative ultrasound investigation gave information about the real anatomic situation of the retina, especially if funduscopy was not possible. The other preoperative parameters could not predict correctly the functional outcome of vitrectomy in diabetics with severe central fibrovascular membranes because of the damage of the optic nerve and the retina. CONCLUSIONS The high rate of anatomical reattachment after vitrectomy in diabetic eyes with severe central fibrovascular membranes is associated with a slight improvement of function; only preoperative visual acuity of hand motions or better was associated with an improvement of function.
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Affiliation(s)
- P Meier
- University Eye Hospital, Leipzig, Germany
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Cohen BZ, Wald KJ, Toyama K. Neodymium:YLF picosecond laser segmentation for retinal traction associated with proliferative diabetic retinopathy. Am J Ophthalmol 1997; 123:515-23. [PMID: 9124248 DOI: 10.1016/s0002-9394(14)70177-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the applicability of laser segmentation for severing fibrovascular tissue and hyaloid interfaces in the treatment of tractional complications of proliferative diabetic retinopathy. METHODS A prototype neodymium:yttrium-lithium-fluoride (Nd:YLF) picosecond pulse photodisruptive laser was used in eight eyes (seven patients) with proliferative diabetic retinopathy as part of a Food and Drug Administration-approved phase 1 protocol. There were three indications for treatment: type I: distortion and shallow elevation of the macular caused by taut, adherent, posterior hyaloid interface (two eyes); type II: traction retinal detachment involving the fovea (two eyes); and type III: fovea-threatened, traction retinal detachment (four eyes). Traction release was accomplished by laser segmentation of the detached hyaloid interfaces and fibrotic, contracted proliferative tissue. The Nd:YLF uses low pulse energy (0.10 mJ, 1,000 pulses per second for 10 consecutive seconds) that allows tissue cutting near the retinal surface. RESULTS Both type I eyes had relief of traction forces; visual acuity improved from 20/400 to 20/50 in one eye; the other remained stable. Of the two type II eyes, one had anatomic reattachment of the fovea with improvement in visual acuity (hand movements to 20/50); the second required vitrectomy. Of the four type III eyes, all had anatomic improvement; three maintained pretreatment acuity; the fourth eye developed vitreous hemorrhage at 6 months and underwent vitrectomy. Three treatments (two eyes) caused vitreous hemorrhage that resulted in a transient drop in acuity (1 to 2 lines). No patient developed a retinal break or choroidal hemorrhage. CONCLUSION In a small pilot study, the Nd:YLF laser segmented proliferative tissue near the retinal surface and elevated hyaloid interfaces. In selected cases, this may enable flattening of traction retinal detachment or release of retinal distortion.
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Affiliation(s)
- B Z Cohen
- Retina Associates of New York, NY 10021, USA.
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Bodanowitz S, Hesse L, Weinand F, Kroll P. Vitrectomy in diabetic patients with a blind fellow eye. ACTA OPHTHALMOLOGICA SCANDINAVICA 1996; 74:84-8. [PMID: 8689491 DOI: 10.1111/j.1600-0420.1996.tb00690.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Results of pars plana vitrectomy for complications of proliferative diabetic retinopathy were analysed in 32 consecutive patients with a blind fellow eye due to diabetic eye disease. The mean follow-up period was 22.3 months. Only 16% of all eyes examined had received full scatter photocoagulation prior to referral for vitrectomy. Out of 9 eyes with vitreous haemorrhage, 8 improved to a visual acuity of > or = 0.2 postoperatively. Amid 23 eyes which were vitrectomized for advanced traction retinal detachment, only 4 eyes improved to a postoperative visual acuity of > or = 0.02. In this group 12 eyes deteriorated after vitrectomy, 3 eyes progressing to no light perception. The postoperative visual outcome after vitrectomy for traction retinal detachment in this group of diabetics with a blind fellow eye (mean postoperative visual acuity 0.03 +/- 0.05) was significantly worse (p < 0.000) compared to a group of 196 patients with a seeing fellow eye who were vitrectomized for traction retinal detachment at our clinic (mean postoperative visual acuity 0.09 +/- 0.11). Therefore we conclude that traction retinal detachment in this subgroup of patients is a particularly severe presentation of diabetic retinopathy with a guarded functional prognosis after vitrectomy. Our results demonstrate the importance of timely full scatter photocoagulation and early vitrectomy in eyes with progressive fibrovascular proliferation not responding to panretinal photocoagulation. We conclude that especially diabetic patients with a blind fellow eye must be followed closely and assigned to vitrectomy at an earlier stage of their disease in order to improve functional prognosis.
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Affiliation(s)
- S Bodanowitz
- Department of Ophthalmology, Philipps University, Marburg, Germany
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Smiddy WE, Feuer W, Irvine WD, Flynn HW, Blankenship GW. Vitrectomy for complications of proliferative diabetic retinopathy. Functional outcomes. Ophthalmology 1995; 102:1688-95. [PMID: 9098263 DOI: 10.1016/s0161-6420(95)30808-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To quantitate the effect of diabetic vitrectomy on each patient's visual system and function. METHODS The anatomic and visual acuity outcomes of diabetic vitrectomy among three surgeons at one institution over a 4-year time interval were studied. Outcome parameters describing the visual system function were defined and applied to quantitate the effect on visual system disability. RESULTS The anatomic and visual success rates and prognostic factors in the cohort of 213 patients by standard statistical analysis were similar to previous studies. The study eye was the eye with better vision in 68 (32%) patients at the conclusion of the study, and vision was equal to the fellow eye in 35 (16%) patients. The mean impairment of the visual system by the American Medical Association Guidelines for Disability was reduced from 61% preoperatively to 50% postoperatively. The factor associated with greatest degree of reduction of impairment of the visual system was a previtrectomy diagnosis of vitreous hemorrhage. There was at least a one-step improvement of visual system function in 65 (31%) patients. CONCLUSIONS Vitrectomy for complications of severe proliferative diabetic retinopathy is especially valuable in improving the patient's overall visual function.
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Affiliation(s)
- W E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL, USA
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50
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Han DP, Pulido JS, Mieler WF, Johnson MW. Vitrectomy for proliferative diabetic retinopathy with severe equatorial fibrovascular proliferation. Am J Ophthalmol 1995; 119:563-70. [PMID: 7733181 DOI: 10.1016/s0002-9394(14)70213-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE We studied the surgical treatment and visual outcome in a consecutive series of eyes with an unusual syndrome of diabetic retinopathy and severe peripheral fibrovascular proliferation involving the equatorial and pre-equatorial fundus. METHODS In a retrospective study of 276 eyes (245 patients) that underwent pars plana vitrectomy for diabetic retinopathy between November 1988 and February 1993, nine eyes of eight patients (3.3% of eyes and 3.3% of patients) had severe equatorial fibrovascular proliferation. The condition occurred primarily in previously unoperated-on eyes (except for panretinal photocoagulation) and resulted in peripheral traction or traction-rhegmatogenous retinal detachment (six eyes), severe vitreous hemorrhage (two eyes), and severe hypotony (one eye). Relief of traction from peripheral fibrovascular membranes was obtained with an encircling scleral buckle (nine eyes) and limited delamination and segmentation (five eyes) or relaxing retinectomy (two eyes). Lensectomy was required for adequate membrane dissection in three eyes. RESULTS After follow-up of six to 52 months (mean, 20.4 months), the visual acuity was 20/200 or better in seven of nine eyes, with complete retinal attachment in seven of nine eyes and postequatorial attachment in all eyes (100%). Poor outcome resulted from a persistent response resembling Coats' disease in one eye and preexistent long-standing retinal detachment in one eye. CONCLUSIONS Vitrectomy for severe equatorial fibrovascular proliferation differs from conventional approaches to diabetic retinopathy in that relief of retinal traction must be attained by scleral buckling and adequate dissection of peripheral fibrovascular tissue. In advanced cases, lensectomy and relaxing retinotomy may be required.
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Affiliation(s)
- D P Han
- Eye Institute, Medical College of Wisconsis, Milwaukee, USA
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