Trimanual Versus Unimanual 23-Gauge Vitrectomy in Patients With Diabetes: Limitations and Expectations

Elwan, Mohamed; Hagras, Sherein M; Ellayeh, Adel

doi:10.3928/23258160-20181212-07

Cited by 3 publications

(11 citation statements)

References 23 publications

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“…Two, both published in the European Vitreoretinal Society (EVRS) Educational Electronic Journal, where irretrievable from Queen’s University library (Belfast, UK) and The British Library (London, UK) and could not be assessed. After full-text evaluation of all other studies, 38 (with 3839 eyes) were found eligible and included . Patients had a median (IQR) age of 52.2 (49.6-55.7) years.…”

Section: Resultsmentioning

confidence: 99%

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Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

et al. 2023

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ImportanceTractional 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.ObjectiveTo determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD).Data SourcesMEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened.Study SelectionEligible 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 SynthesisPreferred 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 MeasuresMain 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.ResultsOf 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 &lt;.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes.Conclusions and RelevanceResults 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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Section: Resultsmentioning

confidence: 99%

“…The meta-analysis of overall final VA included 20 studies (1526 eyes). The pooled final BCVA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71) (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

et al. 2023

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“…The results are presented in Table 1. Overall, the quality of 21 studies was classified as high (4,6,8,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), and five studies were determined to have moderate quality (3,5,7,9,10).…”

Section: Quality Assessment Of the Studiesmentioning

confidence: 99%

“…However, published reports indicate that 0.3%–23.6% of PDR patients still develop NVG even after PPV. 3–28…”

Section: Introductionmentioning

confidence: 99%

The incidence and risk factors of neovascular glaucoma secondary to proliferative diabetic retinopathy after vitrectomy

Sun

Lin

Zeng

et al. 2020

European Journal of Ophthalmology

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Objective: The incidence and risk factors of neovascular glaucoma (NVG) secondary proliferative diabetic retinopathy (PDR) after pars plana vitrectomy (PPV) are unclear and reports in the published literature are inconsistent. Therefore, a systematic review and meta-analysis were conducted to clarify the risk factors associated with neovascular glaucoma. Methods: PubMed, Embase, and The Cochrane Library were systematically searched without language limitations for studies related to NVG after PPV in PDR patients. We used R software to fit the correlation between incidence and the date of publication for studies and performed a Spearman analysis. For binary and continuous variables, the odds ratios (ORs) with 95% confidence intervals (CIs) were pooled, respectively, using Review Manager 5.3 (The Cochrane Collaboration). Results: Twenty-six studies with 5161 patients were included in our meta-analysis. The overall pooled incidence of NVG after PPV in PDR patients was 6% (95% CI, 0.05–0.07, p-value < 0.00001). Pooled estimates indicated a positive correlation for NVG after PPV in PDR patients with higher baseline IOP (OR, 1.26; 95%CI,0.56–1.95, p-value = 0.0004), preoperative iris neovascularization (INV) (OR, 5.66; 95% CI, 2.10–15.23, p-value = 0.0006), preoperative or intraoperative combined cataract surgery (OR, 2.00; 95% CI, 1.15–3.46, p-value = 0.01), postoperative vitreous hemorrhage (VH) (OR, 3.53; 95% CI, 1.63–7.66, p-value = 0.001), and a negative correlation with age (OR, −2.90; 95%CI, −5.00 to −0.81, p-value < 0.007). Conclusion: Our systematic review and meta-analysis indicated that the main risk factors for NVG after PPV in PDR patients included higher baseline IOP, preoperative INV, preoperative or intraoperative combined cataract surgery, postoperative VH, and was negatively correlated with age.

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“…With the en bloc method, the AP traction is left untouched, using it as the "third hand", while with the bimanual method, the membrane is lifted with a pair of forceps in one hand, cutting the pegs with scissors with the other, aided by chandelier lighting. 18 The shaving technique is particularly useful for broad sheets of membrane with multiple, tightly spaced vascular pegs where the delamination technique would be very time consuming. The shaving technique is made possible by small gauge vitrectors (25-G or 27-G) where the ports are located very close to the tip.…”

mentioning

confidence: 99%

Vitrectomy for advanced proliferative diabetic retinopathy: 30 years on

Lim¹,

Lim²,

Bastion³

2020

MyJO

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The scourge of diabetes mellitus continues to ravage the world. South East Asia ranks second among seven geographical regions in absolute numbers of patients with diabetes. 1 In Malaysia, the prevalence of type 2 diabetes mellitus (T2DM) has risen progressively from 11.6% in 2006, to 15.2% in 2011, 2 and 17.5% in 2015. 3 Globally, diabetic retinopathy continues to be among the top five causes of moderate to severe visual impairment. 4 It is among the top three in Malaysia. 5 Globally, about a quarter of T2DM suffers from diabetic retinopathy. 6 Among diabetic patients registered in the Diabetic Eye Registry of Malaysia in 2007, 36% suffers from diabetic retinopathy, 15% from sight-threatening retinopathy, and 7% from proliferative diabetic retinopathy (PDR). 7 The Diabetic Retinopathy Vitrectomy Study (DRVS) was the first landmark study comparing vitrectomy vs observation among patients with advanced PDR. Published in 1985, DRVS Report 2 found no difference in outcome between early vitrectomy vs deferring for a year for vitreous haemorrhage secondary to PDR of T2DM with baseline vision of 5/200 or worse. 8 Early vitrectomy was advantageous for PDR patients with useful vision but mainly those with extensive neovascularization. 9 In fact, 20% in both arms of the study had lost light perception by 2 years.Over the last three decades, significant advancements have contributed to better outcomes for patients with PDR: better laser photocoagulators, anti-vascular endothelial growth factors (anti-VEGF), and better vitrectomy instrumentation. 10 Used in combination, vitrectomy surgeons have achieved progressively better outcomes for advanced PDR patients, 11 with anatomic success rates improving from 66-88% (prior to 1990) to 83.0-92.6% (after 2000) and less than 25% of patients suffering vision loss. 2 Surgical approaches to diabetic tractional retinal detachment (DM-TRD) have advanced over the years from membrane peeling and segmentation, to delamination (with either en bloc dissection 13 or bimanual technique 14 ), and the shaving technique. 15 For a young vitrectomy surgeon just starting out, these techniques may

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Trimanual Versus Unimanual 23-Gauge Vitrectomy in Patients With Diabetes: Limitations and Expectations

Cited by 3 publications

References 23 publications

Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

The incidence and risk factors of neovascular glaucoma secondary to proliferative diabetic retinopathy after vitrectomy

Vitrectomy for advanced proliferative diabetic retinopathy: 30 years on

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