1
|
Wang Q, Zhao J, Xu Q, Han C, Hou B, Huang Y. Visual outcomes and complications following one-way air-fluid exchange technique for vitreous hemorrhage post vitrectomy in proliferative diabetic retinopathy patients. BMC Ophthalmol 2021; 21:129. [PMID: 33750339 PMCID: PMC7941994 DOI: 10.1186/s12886-021-01885-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and outcomes of one-way surgical technique for the treatment of vitreous hemorrhage post vitrectomy on proliferative diabetic retinopathy (PDR) patients. METHODS This retrospective case series include 47 PDR patients who had vitrectomy with balanced saline solution tamponade and have developed vitreous hemorrhage without significant absorption. The one-way air-fluid exchange procedure which involves the application of a 0.22-μm pore size filter to exchange about 4.5-5.5 ml of fluid with a 10 ml syringe was performed on 47 patients (47 eyes). Post procedure, additional treatments were administered when needed. Best corrected visual acuity (BCVA), occurrence of intra-procedural and post-procedural complications were recorded and analyzed. RESULTS A total of 47 eyes of 47 PDR patients with a mean age of 50.8 ± 12.0 years were reviewed. Because of vitreous hemorrhage or tractional retinal detachment of PDR, all 47 eyes underwent vitrectomy with balanced saline solution tamponade prior to the exchange procedure. Four patients (8.51%) and 43 patients (91.5%) were diagnosed with type 1 diabetes mellitus (T1DM), or type 2 diabetes mellitus (T2DM), respectively. All 47 eyes were given the one-way air-fluid exchange procedure in the treatment room. Forty-two cases (89.4%) needed the air-fluid exchange procedure only once, 4 cases (8.51%) underwent the procedure twice, and 1 case (2.13%) was given the procedure three times, followed by additional retinal photocoagulation and one intravitreal injection of Conbercept. In addition to the procedure, no further treatment was needed for 5 eyes (10.6%) while additional retinal laser treatment was provided for 41 eyes (87.2%). The BCVA at the final follow-up was significantly improved from the initial acuity baseline in all cases. No complications were observed during the follow-ups. CONCLUSION This one-way air-fluid exchange procedure can effectively exchange the vitreous hemorrhage and improve visual acuity of PDR patients who develop vitreous rehemorrhage post vitrectomy without obvious complications.
Collapse
Affiliation(s)
- Qun Wang
- Ophthalmology Department, Third Medical Center of PLA General Hospital, No. 69, Yongding Road, Haidian District, Beijing, China.,Ophthalmology Department, First Medical Center of PLA General Hospital, No.29, Fuxing Road, Haidian District, Beijing, China
| | - Jie Zhao
- Ophthalmology Department, Third Medical Center of PLA General Hospital, No. 69, Yongding Road, Haidian District, Beijing, China
| | - Qing Xu
- Ophthalmology Department, Third Medical Center of PLA General Hospital, No. 69, Yongding Road, Haidian District, Beijing, China
| | - Cui Han
- Ophthalmology Department, Third Medical Center of PLA General Hospital, No. 69, Yongding Road, Haidian District, Beijing, China
| | - Baojie Hou
- Ophthalmology Department, Third Medical Center of PLA General Hospital, No. 69, Yongding Road, Haidian District, Beijing, China.
| | - Yifei Huang
- Ophthalmology Department, Third Medical Center of PLA General Hospital, No. 69, Yongding Road, Haidian District, Beijing, China. .,Ophthalmology Department, First Medical Center of PLA General Hospital, No.29, Fuxing Road, Haidian District, Beijing, China.
| |
Collapse
|
2
|
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: 48] [Impact Index Per Article: 9.6] [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.
Collapse
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
| |
Collapse
|
3
|
Faisal SM, Tahir MA, Cheema AM, Anjum MI. Pars plana vitrectomy in vitreous hemorrhage with or without Intravitreal Bevacizumab a comparative overview. Pak J Med Sci 2018; 34:221-225. [PMID: 29643911 PMCID: PMC5857017 DOI: 10.12669/pjms.341.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To compare the success in patients having vitreous hemorrhage undergoing pars plana vitrectomy with or without preoperative intravitreal injection of Bevacizumab. Methods: This Randomized controlled trial was conducted at Department of Ophthalmology, Jinnah Postgraduate Medical Centre. Karachi. Duration of study was six months from January 2010 to June 2010. In this study 56 patients of advanced diabetic eye disease were divided into two groups. Patients in Group-A underwent three ports pars plana vitrectomy with preoperative intravitreal injection of Bevacizumab (Avastin) 1.25mg/0.05ml, 3.5mm from the limbus seven days before surgery and in Group-B patients underwent vitrectomy without preoperative intravitreal Bevacizumab (Avastin). Intraoperative bleeding was monitored in both groups and was graded as no bleeding, mild bleeding and severe bleeding. The results were statistically analyzed through computer software SPSS 17. Results: Twenty eight patients in Group-A who were given an injection of intravitreal Bevacizumab (Avastin) before surgery, intraoperative bleeding monitored was, no bleeding in 17 cases (60.7%), mild was observed in 6 cases (21.4%) and severe bleeding requiring diathermy to stop was observed in only 5 cases (17.9%). 28 patients in Group-B that underwent surgery without Avastin no bleeding was observed in only 2 cases (7.1%), mild in 6 cases (21.4%) and severe in 20 cases (71.4%). Conclusions: Intravitreal injection of Bevacizumab (Avastin) was effective before vitrectomy in the surgical management of Advanced Diabetic Eye disease.
Collapse
Affiliation(s)
- Syed Muhammad Faisal
- Syed Muhammad Faisal, MBBS, FCPS (Ophth). Consultant Ophthalmologist, Ali Trust Eye Hospital, Karachi, Pakistan
| | - Muhammad Ali Tahir
- Muhammad Ali Tahir, MBBS, FCPS (Ophth), FCPS (Vitreoretina). Consultant Retinal Surgeon, Department of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Alyscia Miriam Cheema
- Alyscia Miriam Cheema, MBBS, FCPS, FRCS. Associate Professor and Head, Department Of Ophthalmology, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Muhammad Ijaz Anjum
- Muhammad Ijaz Anjum, MBBS, MCPS, FCPS, FRCS. Chief Consultant, Ali Trust Eye Hospital, Karachi, Pakistan
| |
Collapse
|
4
|
Cruz-Iñigo YJ, Berrocal MH. Twenty-seven-gauge vitrectomy for combined tractional and rhegmatogenous retinal detachment involving the macula associated with proliferative diabetic retinopathy. Int J Retina Vitreous 2017; 3:38. [PMID: 29043092 PMCID: PMC5632824 DOI: 10.1186/s40942-017-0091-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background To report our experience using 27-gauge pars plana vitrectomy (PPV) system for treating patients with combined tractional and rhegmatogenous retinal detachments (CTRRD) involving the macula associated with proliferative diabetic retinopathy (PDR). Methods Retrospective noncomparative interventional cases series of 12 patients with CTRRD associated with PDR who underwent 3-port, transconjunctival 27-gauge PPV by a single surgeon. Main outcome measures were change in Snellen best corrected visual acuity (BCVA) and occurrence of intra- and post-operative complications. Results Twelve eyes from 12 patients (9 men and 3 women) underwent 27-gauge PPV. Mean follow-up was 17 months (range 8–26 months). Preoperatively, BCVA of 20/400 or better was recorded in only 2 of 12 (16.7%) eyes. Postoperatively, BCVA improved to 20/400 or better in 11 of 12 (91.7%) eyes at 6 months (P = 0.001). At last follow-up, BCVA of 20/400 or better was recorded in 10 of 12 (83.3%), in comparison to 2 (16.7%) eyes at baseline (P = 0.004). The only intraoperative complication was an iatrogenic break in 1 eye (8.3%). Postoperative complications included vitreous hemorrhage in 4 eyes (33.3%) and transient ocular hypertension in 3 eyes (25.0%). At final follow-up anatomic success was confirmed in all eyes. Conclusion The current study findings suggest that 27-gauge PPV is a safe and promising surgical technology for treating patients with CTRRD involving the macula associated with PDR. Smaller gauge instruments and higher cutting rates may facilitate the dissection and shaving of fibrovascular membranes, while minimizing intra- and post-operative complications. Electronic supplementary material The online version of this article (doi:10.1186/s40942-017-0091-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yousef J Cruz-Iñigo
- Department of Ophthalmology, Río Piedras Medical Center, University of Puerto Rico, San Juan, 00909 Puerto Rico
| | - María H Berrocal
- Department of Ophthalmology, Río Piedras Medical Center, University of Puerto Rico, San Juan, 00909 Puerto Rico.,Berrocal & Associates, San Juan, Puerto Rico
| |
Collapse
|
5
|
Ramezani A, Ahmadieh H, Rozegar A, Soheilian M, Entezari M, Moradian S, Dehghan MH, Nikkhah H, Yaseri M. Predictors and Outcomes of Vitrectomy and Silicone Oil Injection in Advanced Diabetic Retinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:217-229. [PMID: 28534343 PMCID: PMC5469925 DOI: 10.3341/kjo.2016.0018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/21/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR). METHODS This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate. RESULTS At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. CONCLUSIONS Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.
Collapse
Affiliation(s)
- Alireza Ramezani
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Rozegar
- Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Soheilian
- Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Entezari
- Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad H Dehghan
- Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Ophthalmic Research Center, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Celik E, Sever O, Horozoglu F, Yanyalı A. Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy. Clin Ophthalmol 2016; 10:903-10. [PMID: 27274192 PMCID: PMC4876088 DOI: 10.2147/opth.s95145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP). Patients and methods In this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light. Results The mean follow-up period was 8 months (range: 4–23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye. Conclusion The segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.
Collapse
Affiliation(s)
- Erkan Celik
- Sakarya University Medical Education and Research Hospital, Sakarya, Turkey
| | - Ozkan Sever
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Fatih Horozoglu
- Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Ates Yanyalı
- Haydarpasa Numune Medical Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Current management of vitreous hemorrhage due to proliferative diabetic retinopathy. Int Ophthalmol Clin 2014; 54:141-53. [PMID: 24613890 DOI: 10.1097/iio.0000000000000027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
8
|
Abstract
Surgery for late complications of proliferative diabetic retinopathy remains the cornerstone of management even in patients who have received optimal laser photocoagulation and medical therapy. With improvisation in the surgical techniques and development of micro-incision surgical techniques for vitrectomy, the indications for surgical intervention are expanding to include diabetic macular edema with a greater number of patients undergoing early intervention. This review describes the current indications, surgical techniques, adjunctive anti-vascular endothelial growth factor therapy, surgical outcomes, and postoperative complications of pars plana vitrectomy for proliferative diabetic retinopathy and macular edema.
Collapse
Affiliation(s)
- Vishali Gupta
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | |
Collapse
|