Trimanual vitrectomy for severe proliferative diabetic retinopathy

Purpose

To describe and evaluate a novel technique of pars plana vitrectomy (PPV) under chandelier illumination which is aided with the vital dyes and perfluorocarbon liquids for the management of the complex diabetic vitrectomy cases.

Methods

We conducted a prospective interventional comparative study on 40 eyes of 36 patients with advanced diabetic eye disease requiring PPV. The study was conducted in a single tertiary referral center. Eyes were divided on 1:1 basis by stratified randomization into two groups. Group 1 had trimanual vitrectomy done assisted with chandelier illumination, perfluorocarbon liquid (PFCL) and vital dyes. Group 2 had the conventional bimanual vitrectomy done assisted with chandelier illumination only. All patients were followed up for a minimum of 6 months after the surgery.

Results

Forty eyes of 36 patients with the mean age of 51.42 years (range 28–69) were evaluated. The anatomical success at 6 months could be achieved in all the eyes in both groups. The complete removal of the pre-retinal proliferations could be accomplished in all the eyes in the trimanual PPV group, and only in 85% of the eyes in the bimanual PPV group. Operative time was significantly shorter in the trimanual PPV group (p??6/60) 6 months after the operation compared to the bimanual PPV group (50.0%), but this difference was not statistically significant.

Conclusion

Trimanual PPV is a novel, safe and effective technique that can improve the results of the complex diabetic PPV.