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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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McCullough P, Mohite A, Virgili G, Lois N. Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes: A Systematic Review and Meta-analysis. JAMA Ophthalmol 2023; 141:186-195. [PMID: 36633878 PMCID: PMC9857853 DOI: 10.1001/jamaophthalmol.2022.5817] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/12/2022] [Indexed: 01/13/2023]
Abstract
Importance Tractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy (PPV) is the treatment of choice for TRD. Objective To determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD). Data Sources MEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened. Study Selection Eligible studies were those published in English, those reporting outcomes of PPV for dTRD, and those that included more than 25 eyes and with a minimum follow-up of 3 months. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction/synthesis were followed, and the National Institute for Health quality assessment tool was used to assess risk of bias. Study eligibility was determined independently by 2 reviewers; data extraction was conducted by 1 reviewer and entries checked for accuracy by another. Data were pooled using a random-effects model. Main Outcomes and Measures Main outcomes included rate of failure of retinal reattachment following 1 surgery and final visual acuity (VA). The association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated. Results Of the 406 studies identified, 38 (3839 eyes) were eligible and included for analysis. Patients had a median (IQR) age of 52.2 (49.6-55.7) years. In the studies reporting patient sex (31 of 38 studies), 1441 were female individuals (50.1%). The overall failure rate of retinal reattachment after 1 surgery was 5.9% (95% CI, 1.4%-8.3%), and the mean final VA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71). People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P <.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes. Conclusions and Relevance Results of this systematic review and meta-analysis suggest that PPV was an effective strategy to achieve retinal reattachment in people with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Overall, final postoperative VA remains low, and patients should be counseled on the guarded prognosis of dTRD.
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Affiliation(s)
- Philip McCullough
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Ajay Mohite
- Department of Ophthalmology, The Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Gianni Virgili
- Department of Ophthalmology, The Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Noemi Lois
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- Department of Ophthalmology, The Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Chaban YV, Popovic MM, Garg A, Muni RH, Kertes PJ. Pars Plana Vitrectomy Port Sizes: A Meta-Analysis of Randomized Controlled Trials. Ophthalmic Surg Lasers Imaging Retina 2022; 53:152-158. [PMID: 35272553 DOI: 10.3928/23258160-20220218-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The uptake of small-gauge (SG; ie, 23-gauge [23-G], 25-gauge [25-G], and 27-gauge [27-G]) pars plana vitrectomy (PPV) has grown. We aim to investigate the advantages and disadvantages of various PPV port sizes in a meta-analysis of randomized controlled trials (RCTs). MATERIALS AND METHODS A systematic literature search was performed for RCTs comparing PPV port sizes for any indication. Weighted mean differences (WMDs) and risk ratios (RRs) were calculated, and meta-analysis was performed with random-effects models. RESULTS A total of 1,678 eyes from 22 RCTs were included. Risk-of-bias assessment found some concerns in 13 studies. Compared with 20-gauge PPV, there was no significant difference in the final or change in best-corrected visual acuity (BCVA; five studies analyzed each) relative to that of SG PPV. SG PPV was associated with a significantly greater incidence of hypotony (RR = 3.79; 95% confidence intervals [CI], 2.02 to 7.10; P < .0001; six studies) and choroidal detachment (RR = 5.65; 95% CI, 1.01 to 31.71; P = .05; three studies). Compared with 25-G PPV, there was no significant difference in BCVA at any time point with 23-G (two studies), and significantly more frequent port suturing was required with 23-G (RR = 0.46; 95% CI, 0.25 to 0.84; P = .01; two studies). Compared with 25-G PPV, 27-G was associated with a significantly better final BCVA (WMD = -0.06 logMAR; 95% CI, -0.11 to -0.01; P = .02; five studies) and a significantly lengthened surgery (WMD = 4.11 minutes; 95% CI, 0.18 to 8.05; P = .04; three studies). CONCLUSIONS There was no significant difference in visual or surgical outcomes following 20-gauge PPV relative to SG PPV (Grading of Recommendations, Assessment, Development, and Evaluation recommendation: low certainty), and there was an increased risk of postoperative complications with SG PPV (moderate certainty). Compared with 25-G PPV, 23-G required more frequent port suturing (moderate certainty), whereas 27-G may be associated with a better final BCVA but longer surgery (low and moderate certainty, respectively). [Ophthalmic Surg Lasers Imaging Retina. 2022;53:152-158.].
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Sedova A, Steiner I, Matzenberger RP, Georgopoulos M, Scholda C, Kriechbaum KF, Abela-Formanek C, Mylonas G, Sacu S, Schmidt-Erfurth U, Pollreisz A. Comparison of safety and effectiveness between 23-gauge and 25-gauge vitrectomy surgery in common vitreoretinal diseases. PLoS One 2021; 16:e0248164. [PMID: 33667273 PMCID: PMC7935274 DOI: 10.1371/journal.pone.0248164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/20/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To assess and compare safety and effectiveness between 23-gauge and 25-gauge vitrectomy systems for the treatment of common vitreoretinal diseases in non-vitrectomized eyes. METHODS Retrospective evaluation of patients who underwent pars plana vitrectomy from April 2018 to December 2019 at the Department of Ophthalmology and Optometry at the Medical University of Vienna (MUV) for the following indications: macular epiretinal membrane, macular hole, macular lamellar hole, vitreous hemorrhage, vitreous opacities, vitreomacular traction syndrome and macular edema. RESULTS 201 eyes of 195 patients that underwent 23-gauge (n = 105 eyes) or 25-gauge (n = 96 eyes) vitrectomy were included in this study. The mean best-corrected visual acuity (BCVA) improved at 1-3 months postoperatively and beyond 3 months in both gauge groups. Risk of any complication within 1 month postoperatively was lower in the 25-gauge group, but the difference was statistically not significant (HR [95% CI]: 0.95 [0.53; 1.70], p = 0.85). Intraocular pressure less than 5 mmHg was observed in 2 eyes (2%) in the 23-gauge group at the first postoperative day. Intraocular pressure elevation over 25 mmHg occurred in 5 eyes (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group) at postoperative day 1, between 7 and 28 days in 5 cases (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group), and in 2 eyes (2%) of the 23-gauge group at postoperative day 145 and 61, respectively. Retinal detachment occurred in 1 eye (1%) in the 23-gauge and in 3 eyes (3%) in the 25-gauge group. We did not observe any cases of endophthalmitis. CONCLUSION Results in terms of safety, surgical success and visual outcomes for the treatment of common vitreoretinal surgery indications seem to be comparable between 23-gauge and 25-gauge vitrectomy systems, indicating that the two gauge systems can be used equally in the clinical routine.
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Affiliation(s)
- Aleksandra Sedova
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Irene Steiner
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics, Medical University Vienna, Vienna, Austria
| | | | - Michael Georgopoulos
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Christoph Scholda
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | | | | | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | | | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
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Starr MR, Yonekawa Y, Obeid A, Ryan EH, Ryan C, Ammar M, Patel LG, Forbes NJ, Capone A, Emerson GG, Joseph DP, Eliott D, Regillo CD, Hsu J, Gupta OP, Kuriyan AE. Comparison of Visual and Anatomic Outcomes Following RRD Surgery Using 23-Gauge Versus 25-Gauge Vitrectomy: PRO Study Report No. 12. Ophthalmic Surg Lasers Imaging Retina 2021; 52:70-76. [PMID: 33626167 DOI: 10.3928/23258160-20210201-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Most surgeons now utilize small-gauge (23- or 25-gauge) pars plana vitrectomy (PPV) with or without scleral buckling for repair of rhegmatogenous retinal detachments (RRD), in addition to primary scleral buckle (SB), but comparative data between the two gauges are limited. PATIENTS AND METHODS This study is an analysis of primary RRD repairs comparing 23- versus 25-gauge vitrectomy for PPV or combination PPV/SB from January 1, 2015, through December 31, 2015, across multiple institutions. The primary outcome was single-surgery success and secondary outcomes included postoperative complications. RESULTS There were 1,932 eyes that met inclusion criteria. There was no statistically significant difference in single-surgery success (82.9% vs. 83.8%; P = 0.6329). There were similar rates of postoperative hypotony, endophthalmitis, vitreous hemorrhage, and choroidal detachment. The findings were similar when analyzing only eyes that underwent primary PPV without SB. CONCLUSION Both 23- and 25-gauge vitrectomy systems have similar anatomic and visual outcomes in the primary repair of RRD. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:70-76.].
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Kunikata H, Aizawa N, Sato R, Nishiguchi KM, Abe T, Nakazawa T. Successful surgical outcomes after 23-, 25- and 27-gauge vitrectomy without scleral encircling for giant retinal tear. Jpn J Ophthalmol 2020; 64:506-515. [PMID: 32686061 DOI: 10.1007/s10384-020-00755-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Retinal detachment due to giant retinal tears (GRTs), tears larger than 90°, is rare and difficult to treat. Here, we show and compare surgical results of 23-, 25- and 27-gauge (G) micro-incision vitrectomy surgery (MIVS) for GRT. STUDY DESIGN Retrospective and interventional case series. METHODS Retrospective review of 41 eyes of 38 patients with GRT who underwent MIVS. Surgical outcomes after MIVS, including reattachment rates and postoperative complications, were compared between instrument gauges. All patients were followed for at least 6 months postoperatively. RESULTS MIVS with 23G, 25G and 27G instruments was performed in 7, 19 and 15 eyes, respectively. Silicone oil (SO) was used in 34 of 41 eyes (83%) with a mean removal time of 43.8 days after first surgery. Best-corrected visual acuity (BCVA) was recovered or maintained in 39 eyes (95%). Reattachment was attained after initial surgery in 38 of 41 eyes (93%) (23G: 6/7 [86%]; 25G: 17/19 [89%]; 27G: 15/15 [100%]). Final reattachment was eventually achieved in all eyes (two eyes needed support from scleral encircling). Postoperative complications occurred in 16 eyes (39%) (23G: 3/7 [43%]; 25G: 8/19 [42%]; 27G: 5/15 [33%]), including macular pucker, cystoid macular edema, macular hole, subretinal perfluorocarbon liquid, retinal folds, vitreous hemorrhage and redetachment. There were no significant differences between the three groups in rate of high myopia, GRT size, operation time, phacovitrectomy rate, SO usage rate, initial reattachment rate, final reattachment rate, preoperative BCVA, final BCVA or rate of postoperative complications. CONCLUSION Despite occasional postoperative complications, primary MIVS, regardless of gauge size, appears to be a safe and feasible option for GRT surgery.
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Affiliation(s)
- Hiroshi Kunikata
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Naoko Aizawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Risa Sato
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Koji M Nishiguchi
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiaki Abe
- Division of Clinical Cell Therapy, United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
- Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Clinical comparison of 27-gauge and 23-gauge instruments on the outcomes of pars plana vitrectomy surgery for the treatment of vitreoretinal diseases. Curr Opin Ophthalmol 2020; 31:185-191. [PMID: 32235251 DOI: 10.1097/icu.0000000000000659] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To compare outcomes of 27-gauge and 23-gauge pars plana vitrectomy (PPV) for treatment of vitreoretinal diseases. RECENT FINDINGS Sixty-eight patients undergoing microincisional PPV for treatment of vitreoretinal diseases were randomized 1 : 1 to 27-gauge or 23-gauge surgery with a 7500 cuts-per-minute vitrectomy probe. The most common reasons for vitrectomy were epiretinal membrane (49%) and vitreous hemorrhage (24%). Mean ± standard deviation (SD) changes from immediate preoperative to immediate postoperative intraocular pressure were -0.40 ± 6.60 mmHg in the 27-gauge and -3.05 ± 7.64 mmHg in the 23-gauge group (adjusted mean difference 2.42 mmHg, 95% lower confidence limit 0.64, P = 0.013), but these changes were not associated with primary reason for vitrectomy (P = 0.065). Mean ± SD conjunctival edema grades in the 27-gauge and 23-gauge groups 1 week after surgery were 0.02 ± 0.124 and 0.10 ± 0.246, respectively (least squares mean difference -0.09, 95% upper confidence limit -0.03, P = 0.004), and were 0.01 ± 0.122 and 0.12 ± 0.338, respectively, at the probe incision site. Conjunctival edema grades were similar in both groups at 1 and 3 months. Mean ± SD pain ratings on postoperative day 1 - an indicator of patient comfort - were similar in the two groups. SUMMARY Smaller diameter vitrectomy instruments are associated with smaller reductions in immediate postoperative intraocular pressure.
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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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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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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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BIMANUAL MICROINCISION VITREOUS SURGERY FOR SEVERE PROLIFERATIVE DIABETIC RETINOPATHY. Retina 2018; 38 Suppl 1:S134-S145. [DOI: 10.1097/iae.0000000000002093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takamura Y, Shimura M, Katome T, Someya H, Sugimoto M, Hirano T, Sakamoto T, Gozawa M, Matsumura T, Inatani M. Effect of intravitreal triamcinolone acetonide injection at the end of vitrectomy for vitreous haemorrhage related to proliferative diabetic retinopathy. Br J Ophthalmol 2018; 102:1351-1357. [PMID: 29343528 PMCID: PMC6173818 DOI: 10.1136/bjophthalmol-2017-311377] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/22/2017] [Accepted: 12/16/2017] [Indexed: 12/15/2022]
Abstract
Background/Aims To investigate whether intravitreal injection of triamcinolone acetonide (IVTA) combined with vitrectomy prevents postoperative inflammation in patients with vitreous haemorrhage (VH) due to proliferative diabetic retinopathy (PDR). Methods This prospective, multicentre, randomised study conducted at seven sites in Japan enrolled patients diagnosed as having VH following PDR. Patients underwent vitrectomy with (IVTA+VIT group) or without (VIT group) IVTA at the end of the surgery. Anterior flare intensity (AFI), central retinal thickness (CRT), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured before and at 3 days, 1 week, 1, 3 and 6 months after surgery and compared. Results Number of patients who completed 6 months of follow-up was 40 and 41 in VIT group and IVTA+VIT group, respectively. AFI was significantly higher in the VIT group than in the IVTA+VIT group at 3 days (P=0.033), 1 week (P=0.019) and 1 month (P=0.037). There were no significant differences in CRT, BCVA and IOP between the groups through the observational periods. In the cases with macular oedema >350 µm of CRT at 3 days, CRT was significantly lower in the IVTA+VIT group than in the VIT group at 1 month (P=0.041). Conclusions IVTA combined with vitrectomy and cataract surgery contributed to inhibit the postoperative inflammation in patients with VH due to PDR. The effect of IVTA in the reduction of diabetic macular oedema may be limited to the early stage after surgery. Trial registration number UMIN000020376, Post-results.
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Affiliation(s)
- Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida, Fukui, Japan
| | - Masahiko Shimura
- Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Takashi Katome
- Department of Ophthalmology and Visual Neuroscience, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - Hideaki Someya
- Department of Ophthalmology, National Defense Medical College, Tokorozawa, Japan
| | - Masahiko Sugimoto
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida, Fukui, Japan
| | - Takehiro Matsumura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Yoshida, Fukui, Japan
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Mehta S, Laird P, Debiec M, Hwang C, Zhang R, Yan J, Hendrick A, Hubbard GB, Bergstrom CS, Yeh S, Fernandes A, Olsen TW. Formulation of a Peribulbar Block for Prolonged Postoperative Pain Management in Vitreoretinal Surgery: A Randomized Clinical Trial. Ophthalmol Retina 2017; 2:268-275. [PMID: 31047235 DOI: 10.1016/j.oret.2017.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate postoperative pain level using a supplemental peribulbar injection at the conclusion of retinal surgery. DESIGN Prospective, parallel-assigned, single-masked, randomized clinical trial. PARTICIPANTS Fifty-eight patients undergoing scleral buckle, vitrectomy, or combined surgery. METHODS In a single academic institutional practice, 58 patients undergoing scleral buckle, vitrectomy, or combined surgery were enrolled. Exclusion criteria included those with a risk for glaucoma, a pre-existing chronic pain disorder, among others. Patients were assigned randomly to receive a postoperative peribulbar formulation of either bupivacaine, triamcinolone acetonide, and cefazolin (group A) or bupivacaine, balanced salt solution, and cefazolin (group B). The postoperative pain score and ocular motility were assessed by a masked observer on the first postoperative day. MAIN OUTCOME MEASURES The primary outcome measure was the postoperative pain score. Secondary outcome measures included oral analgesic use, ocular motility, and intraocular pressure (IOP). RESULTS The mean pain scores were 2.8±2.9 for group A and 3.8±2.6 for group B (P = 0.095). Pain was absent in 28% of group A patients versus 14% of group B patients (P = 0.11). Group A required less narcotic pain medication (hydroxycodone: group A, 0.7±3 mg vs. group B, 3±6 mg; P = 0.05; oxycodone: group A, 7±7 mg vs. 9±13 mg; P = 0.2) than group B. Motility was full in group B and limited in group A (P ≤ 0.001), with no differences in mean IOP measurements at any point after surgery. CONCLUSIONS We did not demonstrate a statistically significant reduction in mean postoperative pain scores. However, patients in group A required less hydroxycodone use and had greater akinesia, suggesting prolonged neural blockade.
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Affiliation(s)
- Sonia Mehta
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia; The Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Philadelphia, Pennsylvania
| | - Philip Laird
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia; Retina Care Research Institute of Florida, Palm Beach Gardens, Florida
| | - Matthew Debiec
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia; Madigan Army Medical Center, Tacoma, Washington
| | - Cindy Hwang
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia; The Permanente Medical Group, Vallejo, California
| | - Rui Zhang
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia; Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Jiong Yan
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Andrew Hendrick
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - G Baker Hubbard
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Chris S Bergstrom
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia; Retina Consultants of Carolina, PA, Anderson, South Carolina
| | - Steven Yeh
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Alcides Fernandes
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Timothy W Olsen
- Emory Eye Center, Department of Ophthalmology, Emory University, Atlanta, Georgia.
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Mikhail M, Ali-Ridha A, Chorfi S, Kapusta MA. Long-term outcomes of sutureless 25-G+ pars-plana vitrectomy for the management of diabetic tractional retinal detachment. Graefes Arch Clin Exp Ophthalmol 2016; 255:255-261. [PMID: 27480177 DOI: 10.1007/s00417-016-3442-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/07/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the short- and long-term surgical and clinical outcomes in eyes with diabetic tractional retinal detachment (TRD) undergoing 25-G+ pars-plana vitrectomy (PPV). METHODS A total of 238 patients were reviewed for inclusion in this study. A retrospective cohort study of 109 eyes of 73 patients operated on for diabetic TRD were included. All eyes received intraocular tamponade of air, sulfur hexafluoride, octofluropropane or silicone oil. All patients were followed up for a minimum period of one year. RESULTS The mean age of all patients at surgery was 53.9 years ± 9.2, while the mean duration of diabetes was 18.7 ± 10.4 years. The mean length of follow-up was 923 ± 87 days after surgery (range, 432-1792 days). Thirty-two cases (29.3 %) had an associated rhegmatogenous component. Mean BCVA improved from logarithm minimum angle of resolution (logMAR) 1.17 (20/300) to 0.812 (20/130) (p < 0.05). All eyes underwent intraoperative laser photocoagulation. Primary, single-surgery anatomic reattachment was achieved in 99 eyes (91 %). Final anatomic attachment was achieved in 107 eyes (98 %). There was no statistically significant difference in primary or secondary re-attachment rate in terms of type of tamponade agent used. There were five cases of post-operative hypotony (≤5 mmHg) on postoperative day 1, while 11 eyes had IOP ≥ 30 mmHg. There were no cases of endophthalmitis in our cohort. CONCLUSIONS 25G+ PPV provides for safe and effective repair of diabetic TRDs. Patients experienced positive functional and anatomic outcomes, with no significant intraoperative complications and minimal postoperative sequelae.
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Affiliation(s)
- Mikel Mikhail
- Department of Ophthalmology, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, Québec, H3T1E2, Canada.
| | - Andre Ali-Ridha
- Department of Ophthalmology, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, Québec, H3T1E2, Canada
| | - Sarah Chorfi
- Department of Ophthalmology, Université de Montréal, Montreal, QC, Canada
| | - Michael A Kapusta
- Department of Ophthalmology, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, Québec, H3T1E2, Canada
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15
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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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16
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Sternfeld A, Axer-Siegel R, Stiebel-Kalish H, Weinberger D, Ehrlich R. Advantages of diabetic tractional retinal detachment repair. Clin Ophthalmol 2015; 9:1989-94. [PMID: 26604667 PMCID: PMC4629980 DOI: 10.2147/opth.s90577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose To evaluate the outcomes and complications of patients with diabetic tractional retinal detachment (TRD) treated with pars plana vitrectomy (PPV). Patients and methods We retrospectively studied a case series of 24 eyes of 21 patients at a single tertiary, university-affiliated medical center. A review was carried out on patients who underwent PPV for the management of TRD due to proliferative diabetic retinopathy from October 2011 to November 2013. Preoperative and final visual outcomes, intraoperative and postoperative complications, and medical background were evaluated. Results A 23 G instrumentation was used in 23 eyes (95.8%), and a 25 G instrumentation in one (4.2%). Mean postoperative follow-up time was 13.3 months (4–30 months). Visual acuity significantly improved from logarithm of the minimum angle of resolution (LogMAR) 1.48 to LogMAR 1.05 (P<0.05). Visual acuity improved by ≥3 lines in 75% of patients. Intraoperative complications included iatrogenic retinal breaks in seven eyes (22.9%) and vitreal hemorrhage in nine eyes (37.5%). In two eyes, one sclerotomy was enlarged to 20 G (8.3%). Postoperative complications included reoperation in five eyes (20.8%) due to persistent subretinal fluid (n=3), vitreous hemorrhage (n=1), and dislocated intraocular lens (n=1). Thirteen patients (54.2%) had postoperative vitreous hemorrhage that cleared spontaneously, five patients (20.8%) required antiglaucoma medications for increased intraocular pressure, seven patients (29.2%) developed an epiretinal membrane, and two patients (8.3%) developed a macular hole. Conclusion Patients with diabetic TRD can benefit from PPV surgery. Intraoperative and postoperative complications can be attributed to the complexity of this disease.
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Affiliation(s)
- Amir Sternfeld
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Ruth Axer-Siegel
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Hadas Stiebel-Kalish
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Dov Weinberger
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Rita Ehrlich
- Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
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COMPARISON OF SURGICAL OUTCOME OF 23-GAUGE AND 25-GAUGE MICROINCISION VITRECTOMY SURGERY FOR MANAGEMENT OF IDIOPATHIC EPIRETINAL MEMBRANE IN PSEUDOPHAKIC EYES. Retina 2015; 35:2115-20. [DOI: 10.1097/iae.0000000000000598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Dikopf MS, Patel KH, Setlur VJ, Lim JI. Surgical outcomes of 25-gauge pars plana vitrectomy for diabetic tractional retinal detachment. Eye (Lond) 2015; 29:1213-9. [PMID: 26183284 DOI: 10.1038/eye.2015.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/26/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the outcomes and complications of 25-gauge (G) pars plana vitrectomy (PPV) for repair of diabetic tractional retinal detachment (TRD). METHODS Retrospective review of consecutive, single-surgeon 25-G PPV cases between July 2007 and July 2014. Seventy eyes from 55 patients were operated on for diabetic TRD; all eyes were tamponaded with sulfur hexafluoride, octofluoropropane, silicone oil, or balanced salt solution. Mean age at surgery was 47.7 years (range 23-76 years), and mean length of follow-up was 713 days (range 90-2368 days; median 671 days). Primary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), anatomic success, redetachment, and endophthalmitis. RESULTS Preoperatively, 49 eyes (70%) had a concurrent rhegmatogenous component (8 of which also had proliferative vitreoretinopathy (PVR)). Mean BCVA improved from logarithm of the minimal angle of resolution 1.59 (20/800, SD 0.88) to 0.68 postoperatively (20/100, 0.77), P-value<0.001. Mean IOP increased from 15.9 to 20 mm Hg 1 day after surgery. Elevated postoperative IOP (≥ 22 mm Hg) occurred in 25 eyes, and low IOP (≤ 5 mm Hg) occurred in 2 eyes. Primary reattachment was achieved in 63 eyes (90%), and final anatomical success occurred in 69 eyes (99%). There were no cases of endophthalmitis. CONCLUSIONS Twenty-five-G PPV repair was safe and effective in the repair of diabetic TRD, including eyes with a combined rhegmatogenous detachment or PVR. Gas, silicone oil, and balanced salt solution tamponading agents all proved to be efficacious in this surgical population.
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Affiliation(s)
- M S Dikopf
- Retina Service, UIC Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - K H Patel
- Retina Service, UIC Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - V J Setlur
- Retina Service, UIC Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - J I Lim
- Retina Service, UIC Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
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Abstract
Vitreoretinal surgery has recently undergone remarkable developments. The introduction of micro-incision vitrectomy surgery using 25- and 23-gauge techniques has led to minimally invasive, faster, safer, and more accurate surgeries. Similarly, intraocular illumination and observation systems have advanced from light pipes to chandelier illumination, slit illumination, wide-angle viewing systems, and intraocular endoscopes. Compared to observation via the cornea and optic media, vitreous surgery using an endoscope is extremely useful, as the endoscope is inserted directly into the eye, circumventing the difficulties of corneal clouding and small pupil diameters. Furthermore, there are no blind spots after surgery. We here discuss the advantages of intraocular endoscope use, the current state of endoscopy-guided vitreoretinal surgery, and its future prospects.
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Affiliation(s)
- Shinichi Kawashima
- Department of Ophthalmology, School of Medicine, Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama-shi, Kanagawa, 2308501, Japan
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