Minimal, Relaxing Membranectomies for the Management of Opacified Hyaloid With Diabetic Tractional Retinal Detachments in Monocular Patients: A Novel Surgical Technique

PURPOSE

Vitrectomy for severe tractional retinal detachments is a high-risk procedure given the surgical complexity and potential for postoperative complications. The risk is compounded when operating on monocular patients. We developed a novel technique using hyaloidal removal and minimal relaxing membranectomies for tractional retinal detachments with an opacified hyaloid over the fovea in monocular, diabetic patients and evaluated complications and outcomes.

METHODS

The technique was performed in nine monocular, diabetic patients with decreased visual acuity from opaque hyaloid with centripetal tractional retinal detachments. Outcomes included postoperative best-corrected visual acuity, retinal reattachment rate, redetachments, and complications.

RESULTS

Average age was 58 years (range 43-74) and the average follow-up time was 43.6 months (range 36-64). Preoperative best-corrected visual acuity ranged from 1.0 to 2.3 logMAR (20/200 - Hand Motion) with a mean of 1.39 logMAR (20/500). Postoperative best-corrected visual acuity at last follow-up ranged from 0.2 to 1.0 logMAR (20/30-20/200) with a mean of 0.49 logMAR (20/60) ( P < 0.001). All eyes had attached posterior poles at last follow-up. Complications were observed in two eyes and included nonclearing hemorrhage and capsular opacity.

CONCLUSION

Vitrectomy with minimal, relaxing membranectomies is an option for monocular patients in whom intervention is needed, but are at high risk for complications.

Vision-Related Quality of Life After Vitrectomy: Cross-Sectional Study from Jordan

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.

Prognostic factors of revitrectomy for complications in eyes with proliferative diabetic retinopathy: a retrospective multicentre study

PURPOSE

To identify prognostic factors for revitrectomy in patients who underwent vitrectomy for complications with proliferative diabetic retinopathy (PDR) in multicentre study.

METHODS

Consecutive 452 eyes of 452 patients with PDR undergoing 25-gauge microincision vitrectomy system (MIVS) in seven centres were retrospectivity reviewed. Preoperative ocular factors (baseline visual acuity [VA], vitreous haemorrhage [VH], tractional retinal detachment [TRD] and retinal photocoagulation), general factors (sex, age, diabetes duration, HbA1c level, hypertension, anti-coagulant medication and estimated glomerular filtration rate), surgical procedures (preoperative anti-vascular endothelial growth factor injection, internal limiting membrane peeling, combined cataract surgery, retinal break, and tamponade), postoperative complications for revitrectomy and postoperative VA at 6 months were evaluated.

RESULTS

In the follow-up period of 6 months, revitrectomy was performed in 56 eyes (26.3%), and postoperative complications for revitrectomy were VH in 31 eyes (15%), TRD in 13 eyes (6.2%) and membrane proliferation in 12 eyes (5.2%). The mean LogMAR improvement from baseline to 6 months in revitrectomy group (0.39) was significantly worse than in single vitrectomy group (0.74). Diabetic duration, low baseline VA, less simple VH, TRD and air tamponade were statistical risk factors of revitrectomy, and logistic regression analysis identified low baseline VA and air tamponade also as prognostic factors of revitrectomy.

CONCLUSION

Our results indicated that prognosis of VA was worse in PDR patients with revitrectomy and low baseline VA and air as the tamponade material were the potential prognostic factors of revitrectomy.

Outcomes of vitrectomy for diabetic tractional retinal detachment in Chicago's county health system

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.

VISUAL AND ANATOMICAL OUTCOMES AFTER DIABETIC TRACTION AND TRACTION-RHEGMATOGENOUS RETINAL DETACHMENT REPAIR

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.

Surgical management of diabetic tractional retinal detachments

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.

The Relationship between Carotid Intima-Media Thickness and Ocular Circulation in Type-2 Diabetes

Purpose

To compare clinical findings, including ocular blood flow and intima-media thickness (IMT) of the carotid artery, in mild nonproliferative diabetic retinopathy (NPDR) and no diabetic retinopathy (NDR) patients, and to determine risk factors contributing to mild NPDR.

Methods

In 129 subjects (129 eyes) with type-2 diabetes patients and mild NPDR or NDR, standard statistical techniques were used to determine associations between clinical findings, including diabetes duration, blood levels of creatinine and hemoglobin A1c (HbA1c), central macular thickness (CMT; measured with optical coherence tomography), mean blur rate (MBR; measured with laser speckle flowgraphy), and ultrasound-measured carotid IMT.

Results

Diabetes duration, IMT, and CMT were significantly higher in the mild NPDR patients than the NDR patients (P=0.004, P=0.004, and P=0.003, respectively), while conversely, MBR in the overall optic nerve head (MBR-A) was lower in the mild NPDR patients. Furthermore, a logistic regression analysis showed that diabetes duration (OR, 1.11; P=0.006), diastolic blood pressure (OR, 0.93; P=0.025), heart rate (OR, 1.07; P=0.004), IMT (OR, 8.65; P=0.005), and CMT (OR, 1.03; P=0.007) were independent contributing factors to mild NPDR. Spearman's rank correlation test also showed that IMT was negatively correlated with MBR-A (P=0.011).

Conclusions

Increased IMT showed a close association with ocular ischemia in patients with type-2 diabetes and contributed to the presence of mild NPDR. These findings suggest that IMT may be an early biomarker of mild NPDR.

Soloist performance of vitrectomy probe in proliferative diabetic retinopathy

Purpose:

To evaluate the feasibility and outcomes of the sole use of 23g pars plana vitrectomy in cases with diabetic vitreous hemorrhage with vitreoretinal traction.

Methods:

Prospective interventional case series involving patients between January 2013 and January 2018. All eyes underwent 23g pars plana vitrectomy with internal tamponade. Intraoperative parameters including ancillary instruments, the methods used for hemostasis and complications were all recorded. Postoperative parameters including anatomic success rate, functional success, and postoperative complications were recorded and analyzed. Patients were followed up for at least 12 months.

Results:

A total of 68 eyes of 66 patients were included. Intraoperative ancillary instruments were required in 5 (7.4%) eyes. None of the cases required the use of chandelier illumination, endodiathermy, or scissors. Mean best-corrected visual acuity improved significantly from LogMAR 1.67 ± 0.63 preoperative to 1.22 ± 0.38 at 1-year follow-up (P = 0.005). Functional success was achieved in 37 (54.4%) eyes at 1-year follow-up. Iatrogenic breaks occurred in 3 (4.4%) eyes, vitreous hemorrhage in 4 (5.9%) eyes, and epiretinal membranes in 3 (4.4%) eyes. Repeated vitrectomy was done in 3 (4.4%) eyes.

Conclusion:

The 23g vitrectomy probe proved to be a safe, effective, and beneficial single tool that could accomplish the diabetic vitrectomy mission exclusively with minimal aid from other instruments in cases with vitreous hemorrhage associated with vitreoretinal traction.

The Relationship between Peripheral Nerve Conduction Velocity and Ophthalmological Findings in Type 2 Diabetes Patients with Early Diabetic Retinopathy

PURPOSE

Nerve conduction velocity (NCV) is an indicator of neuronal damage in the distal segment of the peripheral nerves. Here, we determined the association between NCV and other systemic and ocular clinical findings, in type 2 diabetes patients with early diabetic retinopathy (DR).

METHODS

This study included 42 eyes of 42 type 2 diabetes patients (median age: 54 years) with no DR or with mild nonproliferative DR. Standard statistical techniques were used to determine associations between clinical findings.

RESULTS

Sural sensory conduction velocity (SCV) and tibial motor conduction velocity (MCV) were significantly lower in mild nonproliferative DR patients than patients with no DR (P = 0.008 and P = 0.01, resp.). Furthermore, logistic regression analyses revealed that sural SCV and tibial MCV were independent factors contributing to the presence of mild nonproliferative DR (OR 0.83, P = 0.012 and OR 0.69 P = 0.02, resp.). Tibial MCV was correlated with choroidal thickness (CT) (P = 0.01), and a multiple regression analysis revealed that age, tibial MCV, and carotid intima-media thickness were independent associating factors with CT (P = 0.035, P = 0.015, and P = 0.008, resp.).

CONCLUSIONS

Our findings suggest that reduced NCV may be closely associated with early DR in type 2 diabetes patients. Thus, reduced nerve conduction is a potential early biomarker of DR.

Metabolomic profiling of reactive persulfides and polysulfides in the aqueous and vitreous humors

We investigate the metabolomic profile of reactive persulfides and polysulfides in the aqueous and vitreous humors. Eighteen eyes of 18 consecutive patients with diabetes mellitus (DM) and diabetic retinopathy underwent microincision vitrectomy combined with cataract surgery. Samples of the aqueous and vitreous humors were collected and underwent mass spectrometry-based metabolomic profiling of reactive persulfides and polysulfides (polysulfidomics). The effect of reactive polysulfide species on the viability of immortalized retinal cells (the RGC-5 cell line) under oxidative stress (induced with H₂O₂) was also evaluated with an Alamar Blue assay. The experiments showed that cysteine persulfides (CysSSH), oxidized glutathione trisulfide (GSSSG) and cystine were elevated in the aqueous humor, and CysSSH, Cys, and cystine were elevated in the vitreous. Furthermore, GSSSG, cystine, and CysSSH levels were correlated in the aqueous and vitreous humors. A comparison, in DM and control subjects, of plasma levels of reactive persulfides and polysulfides showed that they did not differ. In vitro findings revealed that reactive polysulfide species increased cell viability under oxidative stress. Thus, various reactive persulfides and polysulfides appear to be present in the eye, and some reactive sulfide species, which have a protective effect against oxidative stress, are upregulated in the aqueous and vitreous humors of DM eyes.

Characteristics of cases with postoperative vitreous hemorrhage after 25-gauge vitrectomy for repair of proliferative diabetic retinopathy

PURPOSE

The purpose of this study was to compare ocular and systemic parameters between proliferative diabetic retinopathy (PDR) cases with postoperative vitreous hemorrhage (PVH) and those without PVH after 25-gauge vitrectomy, and to investigate the predictors of PVH.

METHODS

The medical records of 106 eyes of 78 consecutive patients who underwent primary 25-gauge vitrectomy were reviewed.

RESULTS

The incidences of early and late PVH were found to be 18.9 % (20/106 eyes) and 17.9 % (19/106 eyes) respectively. On multiple logistic regression analysis, intraoperative bleeding from new vessels on the disc was identified as the most important factor, with the greatest odds ratio, for the development of early PVH (odds ratio = 3.395, P = 0.134), while the HbA1c level was identified as the most important significant factor, with the greatest odds ratio, for the development of late PVH (odds ratio = 1.403, P = 0.014).

CONCLUSIONS

Early PVH tends to occur in severe PDR cases, while late PVH tends to occur in cases with poor diabetic control.

The relationship between advanced glycation end products and ocular circulation in type 2 diabetes

AIMS

To determine whether skin autofluorescence (SAF) and serum pentosidine, biomarkers of advanced glycation end products (AGEs), were associated with ocular microcirculation in type 2 diabetes patients with early diabetic retinopathy (DR).

METHODS

This study included 46 eyes of 46 type 2 diabetes patients with no DR or non-proliferative DR. SAF was measured with an autofluorescence reader. Optic nerve head (ONH) microcirculation, represented by mean blur rate (MBR), was measured with laser speckle flowgraphy. Overall MBR, vascular MBR, and tissue MBR were calculated in software. MBR, SAF, pentosidine levels, and clinical findings, including central macular thickness (CMT), were then compared.

RESULTS

SAF in the diabetes patients was correlated with age (P=0.018). Serum pentosidine was correlated with age, vascular MBR and tissue MBR (P=0.046, P=0.035, and P=0.01, respectively). CMT was correlated with tissue MBR (P=0.016), but not with vascular MBR or overall MBR. Separate multiple regression analyses of independent contributing factors revealed that age, SAF, serum pentosidine, duration of diabetes, and pulse rate contributed to tissue MBR (P=0.041, P=0.046, P=0.022, P=0.011 and P=0.036, respectively), while SAF, HbA1c, pulse rate, tissue MBR, diastolic blood pressure, and creatinine contributed to CMT (P=0.005, P=0.039, P<0.001, P<0.001, P=0.022 and P=0.001, respectively).

CONCLUSIONS

Tissue MBR may be closely related to AGE levels and CMT in type 2 diabetes patients with early DR, suggesting that ocular circulation might be potential early biomarkers of DR.

A Comparison of Immediate and Delayed Vitrectomy for the Management of Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy

BACKGROUND AND OBJECTIVE

To compare immediate and delayed vitrectomy for the management of vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR).

PATIENTS AND METHODS

Retrospective review of 134 eyes receiving vitrectomy for non-clearing, PDR-associated VH. Primary outcome was area under the vision curve (AUC) in patients receiving immediate (< 30 days) versus delayed (> 30 days) vitrectomy with endolaser.

RESULTS

Forty-six eyes were included, with 17 undergoing immediate (< 30 days) vitrectomy with endolaser and 29 undergoing delayed (> 30 days) vitrectomy with endolaser. Time to vitrectomy was 14.8 days ± 8.26 days compared to 629.6 days ± 894.9 days in the immediate and delayed groups, respectively. AUC was significantly greater for patients undergoing delayed versus immediate vitrectomy (276.1 ± 0.601 logMAR*time versus 165.7 ± 0.761 logMAR*time; P < .0001). There was no difference in AUC postoperatively for delayed versus immediate surgery. Both groups required significantly less postoperative panretinal photocoagulation (P < .05). Preoperative and final visual acuities were equivalent (immediate: 1.86 ± 0.99 and 0.35 ± 0.25; P = .002; delayed: 1.71 ± 1.05 and 0.31 ± 0.34; P < .0001).

CONCLUSIONS

Immediate vitrectomy with endolaser for PDR-associated VH (< 30 days) decreases time spent with vision loss and the need for adjunctive PRP. Modern vitrectomy is safe and may be considered earlier in VH management.

Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy

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.

Evaluation of microincision vitrectomy surgery using wide-viewing system for complications with ocular sarcoidosis

We evaluate the outcomes of microincision vitrectomy surgery (MIVS) using wide-viewing system for complications with ocular sarcoidosis resistance to medical treatment.Consecutive clinical records of 24 eyes (19 patients) with complications of ocular sarcoidosis underwent MIVS between April 2010 and December 2013 were retrospectively reviewed. MIVS and phacoemulsification were performed in 18 eyes and MIVS only in 6 eyes. Best-corrected visual acuity (BCVA), inflammation scores in the anterior segment and in the posterior segment, and central retinal thickness (CRT) of eyes with cystoid macular edema (CME) before surgery and after 1 week, 1, 3, 6, and 12 months were evaluated.LogMAR (log of the minimum angle of resolution) converted from BCVA was improved in 83.3% after 12 months and 66.7% showed improvement of more than 2 lines. The mean LogMAR was significantly improved from 1.14 ± 1.18 to 0.36 ± 0.79 in all eyes and 0.83 ± 0.86 to 0.23 ± 0.41 in eyes with MIVS and phacoemulsification, although no improvement was observed in eyes with MIVS only. Significant decrease of the mean anterior inflammation score was observed after 1 month in eyes with MIVS only and after 12 months in eyes with MIVS and phacoemulsification, and the mean posterior inflammation scores decreased after 1 week in all eyes. In eyes with preoperative CME, mean CRT was significantly decreased from 1 week after surgery. There was no case in which ocular inflammation was exacerbated by surgical stress. Improvement of visual acuity and resolution of ocular inflammation could be achieved by MIVS using wide-viewing system for complications of ocular sarcoidosis.

23-gauge versus 25-gauge vitrectomy for proliferative diabetic retinopathy: a comparison of surgical outcomes

PURPOSE

This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy.

STUDY DESIGN

It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications.

RESULTS

Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014).

CONCLUSION AND MESSAGE

Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.

Advances in diabetic retinopathy

Diabetic retinopathy (DR) is a complication of long-term diabetes mellitus (DM). Over the last 2 decades lot of work has been on early diagnosis of DR and screening programs have been designed to help the masses. Large numbers of clinical studies have been done for patients of diabetes and DR wherein the role of blood sugar control, metabolic control, role of oral medicines for DR, role of imaging, fluorescein angiography, and retinal photocoagulation has been studied. Newer treatment modalities are being devised and studied for better patient care. We discuss these issues in our review highlight and newer advances over the last few years.

Relationship of skin autofluorescence to severity of retinopathy in type 2 diabetes

PURPOSE

To evaluate the relationship between skin autofluorescence (SAF), which reflects the accumulation of advanced glycation end products (AGEs), and the severity of diabetic retinopathy (DR) in patients with type 2 diabetes.

METHODS

Sixty-seven eyes of 67 patients with type 2 diabetes were enrolled. Sixty-seven age-matched non-diabetic subjects served as controls. Diabetic patients were classified by the severity of their DR: no DR (NDR), non-proliferative DR (NPDR), and proliferative DR (PDR). SAF was measured with an autofluorescence reader.

RESULTS

SAF in the diabetes patients was significantly higher than in the controls (median 2.5 (interquartile range 2.3-2.7) and 1.8 (1.6-2.3) arbitrary unit (AU), respectively, p < 0.001). There was a statistically significant increase in SAF along with the increasing severity of DR (from NDR to NPDR: p = 0.034; NPDR to PDR: p < 0.01). Logistic regression analysis revealed that SAF (OR, 17.2; p < 0.05) was an independent factor indicating the presence of PDR.

CONCLUSIONS

SAF has an independent relationship with PDR in patients with type 2 diabetes. SAF measurement with an autofluorescence reader is a non-invasive way to assess the risk of DR. SAF may, therefore, be a surrogate marker candidate for the non-invasive evaluation of DR.

Twenty-five-gauge vitrectomy for the removal of 5000 centistokes silicone oil

PURPOSE

To compare the safety and efficacy of removing 5000 centistokes silicone oil between 20-gauge and 25-gauge vitrectomy technique.

METHODS

Prospective case series of 34 consecutive patients undergoing 5000 centistokes silicone oil removal using 20-gauge or 25-gauge cannulas. The main outcome measures were the safety and efficacy of silicone oil removal. The safety was evaluated by recording intraoperative and postoperative complication rates, including bleeding, recurrence of retinal detachment, hypotony, choroidal detachment, corneal edema, endophthalmitis, vitreous hemorrhage, conjunctival injection, and subconjunctival hemorrhage. The efficacy was judged by the ability to attain the complete removal of silicone oil and the total surgical time to complete the procedure.

RESULTS

Sixteen patients underwent 20-gauge vitrectomy for the removal of 5000 centistokes silicone oil between January 2008 and January 2010, and 18 patients underwent 25-gauge vitrectomy for the removal of 5000 centistokes silicone oil from January 2010 to August 2012. Silicone oil was successfully removed completely in all cases. Using 25-gauge vitrectomy to remove silicone oil was significantly more time efficient with the mean total surgical time of 25 ± 6 minutes compared with 42 ± 10 minutes in 20-gauge vitrectomy group (P < 0.05). There were no differences in the intraoperative or postoperative complication rates between the two groups. None of the patients developed postoperative recurrence of retinal detachment, hypotony, choroidal detachment, corneal edema, endophthalmitis, or vitreous hemorrhage.

CONCLUSION

Twenty-five-gauge silicone oil removal is safe and effective. Surgical time is significantly reduced using sutureless 25-gauge sclerotomies. This may translate to cost reduction by decreasing time spent in the operating room.