Bimanual Microincision Vitreous Surgery for Severe Proliferative Diabetic Retinopathy

Abstract

Sustained visual improvement, anatomical restoration, and low complication rates were obtained in complex situations with bimanual microincision vitreous surgery in a large series. Visual outcomes were poorer in older age group, tractional retinal detachments involving macula, and eyes with extensive membranes and with silicone oil as tamponade. Both 23-gauge and 25-gauge groups were comparable in relation to visual improvement, anatomical success, and intraoperative and postoperative complications.

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

“…Before 2007, the overall rate for final retinal reattachment in TRD repair ranged from 53–88%[19–22] and the rate of reoperation was between 16–43% for TRD[19,20,22]. After 2007, the overall rate for final reattachment in TRD repair improved to 67%-100% [5,8,9,23–34] and the rate of reoperation decreased slightly to 6–31% [24,25,28,30,35]. The high reoperation rate both before and after 2007 is likely due to complications that can develop after diabetic vitrectomy.…”

“…Other common complications include secondary retinal detachment in up to 36% of cases, AHFVP in up to 13% of cases, and fibrinoid syndrome in up to 5% of cases, which represent serious conditions that require repeat vitrectomy and can significantly affect final vision[8],[5,32,40,41],[42]. Neovascular glaucoma occurred in 0–29% of cases before 2007[19–22,43–45] and 0–8% after 2007[5,8,9,18,25–28], with increased incidence in cases with lens removal during vitrectomy[32,46–48].…”

“…Studies assessing visual outcomes for TRD repair typically report reaching postoperative visual acuity > = 20/100 in 7%-43% of cases, > = 20/200 in 36.2–62.5% of cases, > = 5/200 in 67–77% of cases, and visual improvement in up to 90% of cases [9,19–23,26,39,43,45,46,49–53]. In our series, 69.6% of eyes were characterized by preoperative macular involvement and 44.9% by combined TRD/RRD, with 55.1% of eyes reaching postoperative acuity > = 20/100, 71.0% of eyes reaching > = 20/200, 78.3% of eyes reaching > = 5/200, and visual improvement in 88.4% of eyes.…”

“…The surgical repair of diabetic TRD is among the most challenging surgeries for a vitreoretinal specialist due to the friable nature of the ischemic retina and the presence of extensive fibrovascular membranes[5]. Despite the difficulty of repair, recent advancements in vireoretinal surgery, including smaller gauge instruments, wide angle viewing systems, use of tamponade, self-retaining endoillumination, and the development of medications targeting vascular endothelial growth factor, have greatly improved outcomes in complex TRD cases[6–9].…”

Diabetic Retinopathy and Blindness: An Epidemiological Overview

“…The introduction of small-gauge vitrectomy instruments and trans-scleral cannulas enabled the fast and effective removal of most fibrovascular membranes with the vitrectomy probe applying the lift and shave technique [93]. Visual outcomes were poorer in older age group, tractional retinal detachments involving macula and eyes with extensive membranes and with silicone oil as tamponade; however both 23-gauge and 25-gauge groups were comparable in relation to visual improvement, anatomical success, and intraoperative Diabetic Retinopathy and Blindness: An Epidemiological Overview DOI: http://dx.doi.org /10.5772/intechopen.88756 and postoperative complications [94]. The integration of swept-source optical coherence tomography and digital displays can provide important guidance during surgery for PDR complications and facilitate decision-making [95]; however further research will show whether these technological advances will translate into better postoperative visual outcome.…”