Vitrectomy in the management of diabetic eye disease.

Vitrectomy techniques including endolaser photocoagulation allow visual rehabilitation in many eyes that are otherwise untreatable. Discerning the indications and timing for diabetic vitrectomy is increasingly important as the treatment of complications of diabetic retinopathy continues to undergo modification and redefinition. The most common indications for diabetic vitrectomy include: 1) severe nonclearing vitreous hemorrhage; 2) traction retinal detachment recently involving the macula; 3) combined traction and rhegmatogenous detachment; 4) progressive fibrovascular proliferation; and 5) rubeosis iridis and vitreous hemorrhage for eyes in which the media opacity has prevented adequate laser photocoagulation. Other less common indications in selected cases include dense premacular hemorrhage, ghost cell glaucoma, macular edema with premacular traction, cataract preventing treatment of severe, proliferative diabetic retinopathy, anterior hyaloidal fibrovascular proliferation, and fibrinoid syndrome with retinal detachment. The rationale and surgical objectives are discussed and results are summarized.     

Different outcome among eyes with proliferative diabetic retinopathy indicated for vitrectomy

PURPOSE: The postoperative outcome was evaluated in each group of surgical indications of vitreous surgery for proliferative diabetic retinopathy (PDR), to investigate the factors responsible for postoperative visual prognosis. METHODS: Primary vitrectomy was performed in 119 eyes of 92 patients with PDR. Average postoperative follow-up period was 19 months. The indications for vitrectomy included vitrous hemorrhage in 58 eyes, macular tractional retinal detachment in 17 eyes, extramacular tractional retinal detachment in 10 eyes, macular heterotopia in 11 eyes, and progressive fibrovascular proliferation in the posterior fundus in 23 eyes. RESULTS: The visual acuity finally improved by 2 lines or more in 91 eyes (77%), remained unchanged in 10 eyes (8 %), and decreased by 2 lines or more in 18 eyes (15%). Final postoperative visual acuity was significantly better in cases of vitreous hemorrhage or progressive fibrovascular proliferation in the posterior fundus than in others. Preoperative rubeosis iridis and macular tractional retinal detachment were probably responsible for the final visual impairment, and intraocular tamponade affected the difference in visual prognosis between the groups of surgical indication. Multivariate analysis in all cases revealed that factors influencing visual outcome were preoperative rubeosis iridis and anemia. CONCLUSION: Rubeosis iridis and macular tractional retinal detachment were prognostic factors of the surgery. Vitrectomy for PDR may be effective in improving postoperative visual acuity if performed in the early stage of progressive fibrovascular proliferation in the posterior fundus after sufficient retinal photocoagulation.     

Viscodelamination at the vitreoretinal juncture in severe diabetic eye disease.

Injection of 1% methylcellulose or 1% sodium hyaluronate (Healonid) was used to separate attached vitreous cortex and fibrovascular epiretinal membranes from the retina in 40 eyes undergoing closed microsurgery for severe diabetic eye disease. The viscodelamination technique was of great value in elevating vitreous cortex or sparsely vascularised epiretinal membranes, especially in eyes with combined traction and rhegmatogenous retinal detachment. However, bleeding from or tearing of the retina limited the usefulness of this technique in the surgery of highly vascularised and adherent membranes, as in eyes with table-top traction retinal detachment. Recurrent epiretinal membrane proliferation was seen in some eyes postoperatively.     

Anterior hyaloidal fibrovascular proliferation after diabetic vitrectomy

Vitrectomy was performed to treat 74 consecutive eyes for complications of diabetic retinopathy. Eight (13%) of 61 eyes followed up for an average of 12 months developed anterior hyaloidal fibrovascular proliferation. This was the most common postoperative complication, whose features included recurrent hemorrhages into the vitreous cavity or anterior vitreous, or both; vessels or fibrovascular tissue on the posterior lens capsule; anterior extraretinal vascularization extending toward the lens on the anterior hyaloid; traction detachment of the peripheral retina or ciliary body; and hypotony. Patients who developed this complication tended to be young males with severe retinal neovascularization and extensive retinal ischemia; traction retinal detachment as an indication for surgery; placement of a scleral buckle; postoperative rubeosis iridis, recurrent vitreous hemorrhages, and retinal detachment; and multiple surgeries. Four eyes progressed to atrophia bulbi. Early recognition followed by additional surgery in two patients and extensive additional photocoagulation in two other patients was successful in preserving good visual function.     

视网膜孔源性玻璃体出血23例临床分析

目的:探讨视网膜裂孔源性玻璃体出血的发病原因、临床特征和治疗效果。方法:收集了自发性玻璃体出血病例23眼,玻璃体出血原因均为马蹄形视网膜裂孔伴裂孔区血管撕裂所致,2眼为单纯视网膜裂孔并发玻璃体出血,21眼为孔源性视网膜脱离并发玻璃体出血;3眼行单纯激光治疗,20眼行外路视网膜脱离手术或玻璃体切除手术。结果:经激光或手术治疗后23眼均无出血复发,裂孔封闭,22眼视力好于或等于术前,1眼视网膜脱离复发为牵拉型视网膜脱离。结论:孔源性玻璃体出血是玻璃体积血的重要原因之一,尽早明确诊断、及时治疗可以取得满意疗效,避免严重并发症。     

进展型增生性糖尿病视网膜病变玻璃体 切割手术的价值与意义

目的了解有不同并发症的进展型增生性糖尿病视网膜病变眼进行玻璃体手术的结果。方法将患有Ⅰ、Ⅱ型糖尿病进展型增生性糖尿病视网膜病变的314只眼分为玻璃体积血合并局限牵拉性视网膜脱离组;广泛纤维血管膜合并牵拉性视网膜脱离组;牵拉孔源混合性视网膜脱离组;玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组,分别进行回顾性分析。结果玻璃体积血合并局限牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患 者手术后获得0.1以上视力的分别占39.4%和66.7%,广泛纤维血管膜合并牵拉性视网膜脱离组中Ⅰ、Ⅱ型糖尿病患者手术后获得0.1以上视力的分别占31.6%和51.6%,牵拉孔源混合性视网膜脱离组手术后获得0.1以上视力者占31.6%,玻璃体积血视网膜脱离合并老年性白内障行玻璃体手术联合白内障摘除及人工晶状体植入组手术后获得0.1以上视力者占62.5%。首要的术中 并发症是医源性视网膜裂孔,术后视力丧失的主要原因包括新生血管性青光眼、视网膜脱离和视网膜中央动脉阻塞。结论玻璃体切割手术联合全视网膜光凝术,能有效地改善进展性糖尿病视网膜病变患者的视力。(中华眼底病杂志,2001,17:171-174)     

Vitreoschisis in Eales' disease: pathogenic role and significance in surgery

PURPOSE: To report the surgical anatomy of vitreoretinal adhesions as observed intraoperatively in patients undergoing vitreous surgery for complications of Eales' disease. METHODS: Eighteen consecutive male patients (18 eyes) undergoing vitrectomy for Eales' disease were studied prospectively. Intraoperative diagnosis was vitreous hemorrhage (VH) in nine cases, traction retinal detachment (TRD) in four, VH and TRD in three, and combined traction-rhegmatogenous retinal detachment in two. Epiretinal membranes (ERMs) obtained during surgery were studied using light microscopy and immunohistochemistry. RESULTS: An incomplete posterior vitreous detachment was observed in all eyes. Multifocal vitreoretinal adhesions were evident in 83.3% of eyes. The proliferation was fibrovascular in 10 eyes and fibrous in eight. A radial traction fold extending from optic disk to periphery was observed in three eyes. A double-layered membrane, probably the result of vitreoschisis, caused tangential traction. ERMs consisted principally of type II collagen and the cellular element was predominantly composed of lymphocytes, glial cells, and macrophage-like cells (probably hyalocytes). CONCLUSIONS: Fibrous and fibrovascular proliferations have multiple areas of adhesions to the posterior vitreous cortex. The presence of type II collagen in the ERM indicates a possible vitreous collagen component to the double-layered membranes (vitreoschisis). Recognition of the double-layered membranes aids in relief of traction during surgery by delamination.     

Combined rhegmatogenous and traction retinal detachment in proliferative diabetic retinopathy: clinical manifestations and surgical outcome

BACKGROUND: Combined rhegmatogenous and traction retinal detachment (combined detachment) is a serious complication in proliferative diabetic retinopathy. The common clinical findings and surgical results of this complication were investigated. METHODS: Forty eyes of 36 consecutive patients with combined detachment undergoing pars plana vitrectomy at a teaching hospital in a 4.5-year period were retrospectively reviewed. All cases had been followed up for at least 6 months. RESULTS: Only 10 of the 40 cases had a preoperative visual acuity better than finger counting vision. Extensive proliferation with multiple, thickened, plaque-like vitreoretinal adhesions and large areas of detachment were noted in 38 cases, 19 cases showing predominantly fibrous tissue and 19 cases presenting with predominantly active fibrovascular proliferation. Two cases had minimal fibrovascular proliferation. Retinal breaks were identified in 7 eyes (17.5%) before surgery and in 33 eyes (82.5%) during surgery. Thirty-seven eyes (92.5%) achieved long-term retinal reattachment. Silicone oil was used in 23 eyes (57.5%). Visual acuity improved in 28 eyes (70%), was unchanged in 6 (15%), and became worse in 6 (15%). In 19 eyes postoperative vision was better than 20/400. Multiple regression analysis showed preoperative visual acuity as the single factor associated with postoperative visual outcome. INTERPRETATION: Combined retinal detachment in proliferative diabetic retinopathy may occur during the stage of active fibrovascular proliferation or as a late complication. It is frequently associated with tightly adherent preretinal tissue and extensive detachment. Preoperative visual acuity best predicts visual prognosis.     

Closed Vitrectomy in the Management of Diabetic Traction Retinal Detachment

One hundred and seventy-four instances of diabetic traction retinal detachment in which the patient underwent closed vitrectomy during the period of January 1970 to December 1978 and had adequate follow-up ranging from six months to five years are reported. As a rule, eyes with vision better than 20/200, or with inaccurate light projection, or with no response to electrophysiologic tests were excluded. The surgical technique avoided stripping of vitreous membranes. Closed vitrectomy was combined with scleral buckling in eyes with retinal breaks, and with scleral resection in eyes with incomplete section of traction membranes. Anatomic improvement was noted in 75.3% of the eyes; vision improved in 64.9% of the eyes; new or recurrent vitreous hemorrhage was observed in 43.1%; corneal decompensation in 51.8%, rubeosis iridis in 23.0%, phthisis bulbi in 9.2%, iatrogenic retinal break in 8.6%, postoperative rhegmatogenous retinal detachment in 5.2%, and iatrogenic cataract in 4.6%.     

Management of proliferative diabetic retinopathy

Proliferative diabetic retinopathy is characterized by neovascularization originating from the retina and/or optic disk in patients with diabetes mellitus. The role of vascular endothelial growth factor appears to be central in the pathogenesis of proliferative diabetic retinopathy. Advanced glycation end products are important in the development of vitreous abnormalities in proliferative diabetic retinopathy. The majority of the neovascular membranes are adherent to the posterior vitreous cortex. When the posterior hyaloid exerts traction, the edges of the neovascular complex are pulled forward, resulting in vitreous hemorrhage. Tractional and/or rhegmatogenous retinal detachments can occur. The Diabetic Retinopathy Study demonstrated the ability of panretinal photocoagulation to reduce the rate of severe visual loss by 50% for eyes with high-risk characteristics, defined as neovascularization originating from the optic disk > 1/3 disk diameter, any neovascularization originating from the optic disk with hemorrhage, and neovascularization originating from the retina with vitreous hemorrhage. The Early Treatment Diabetic Retinopathy Study showed that patients with type II diabetes mellitus who were older than 40 with severe nonproliferative diabetic retinopathy (defined as hemorrhages in four quadrants, venous beading in two quadrants, or intraretinal microvascular abnormalities in one quadrant) also benefited from early panretinal photocoagulation. The Diabetic Retinopathy Vitrectomy Study showed that early vitrectomy (within 6 months of onset of vitreous hemorrhage) was associated with better results in type I diabetes mellitus patients only. The goals of vitreous surgery are to remove the vitreous, including the posterior hyaloid, and to relieve traction from fibrovascular tissue. Delamination and segmentation techniques have been used in the excision of fibrovascular growth on the internal limiting membrane and extending into the vitreous. Panretinal photocoagulation is an integral component of vitrectomy for proliferative diabetic retinopathy. Anti-vascular endothelial growth factor agents may be used in addition to laser as an adjunct to reduce the risk of neovascularization. Vitrectomy surgery may have intraoperative and postoperative complications, including cataract, anterior hyaloidal fibrovascular proliferation, fibrovascular ingrowth, retinal detachment, and recurrent vitreous hemorrhage. Visual potential depends on the preoperative and postoperative status of the macula, as well as on retinal perfusion and the health of the optic nerve. With the improvement in instruments, techniques, and drugs, the results of vitrectomy in proliferative diabetic retinopathy are improving.     

Long-term results of vitreous surgery for proliferative diabetic retinopathy

In order to study long-term anatomical and functional results the authors evaluated the data from 260 patients who underwent pars plana vitrectomy for proliferative diabetic retinopathy. Indications for surgery were: vitreous hemorrhage, 68 eyes (26.2%); vitreous hemorrhage & tractional retinal detachment, 84 eyes (32.3%); tractional retinal detachment, 82 eyes (31.5%); and combined tractional-rhegmatogenous retinal detachment, 26 eyes (10%). In 118 eyes vitreoretinal surgery was combined with silicone-oil tamponade.The retina was completely attached posterior to a scleral buckle in 251 eyes (96%) at the time of the last examination. After a follow-up period of at least 12 months in a group of patients with vitreous hemorrhage, visual acuity improved in 88% of the eyes. Visual acuity was better than 0.5 in 31% of eyes. In group of eyes with nonresorbing vitreous hemorrhage & tractional retinal detachment visual acuity improved in 52% of eyes. Visual acuity improved in 76% of eyes with tractional retinal detachment and in 81% of eyes with combined tractional & rhegmatogenous retinal detachment. When comparing the latest postoperative visual acuity to visual acuity after three months postoperatively, visual acuity was unchanged in 88%, in 10% it became worse and in 3 cases (1%) became better. In the postoperative period, recurrent vitreous hemorrhage occurred in 33 (13%) eyes, reproliferation in 12 eyes.Cataract developed in 45 of 168 phakic eyes. If postoperative visual acuity before cataract formation was good, extracapsular cataract extraction with posterior chamber intraocular lens implantation was performed. Otherwise simple intra or extracapsular cataract extraction was performed. In 19 cases cataract operation was performed together with silicone oil extraction. Neovascular glaucoma developed postoperatively in 15 eyes (6%). Retinal detachment occurred postoperatively in 21 eyes (8%). In 15 eyes the retina was successfully reattached after additional operations.     

手术治疗先天性视网膜劈裂症眼后段并发症

目的评价玻璃体视网膜手术治疗先天性视网膜劈裂症眼后段并发症的效果。方法回顾性分析伴有眼后段并发症的先天性视网膜劈裂症7例（10眼）玻璃体视网膜手术的效果。其中玻璃体积血5眼，玻璃体积血合并牵引性视网膜脱离1眼，原发性（孔源性）视网膜脱离2眼，周边劈裂腔进展累及黄斑2眼。所有病例均有周边视网膜劈裂及黄斑中心凹劈裂。1眼孔源性视网膜脱离行巩膜扣带术，其余9眼行玻璃体手术。结果随访12～51月，平均38月，玻璃体积血者术后屈光间质透明，视网膜脱离者术后视网膜复位良好，所有病例术后视力较术前均有不同程度提高，而且视网膜劈裂无明显进展。无严重并发症出现。结论玻璃体视网膜手术用于治疗先天性视网膜劈裂症眼后段并发症，不仅可以清除浑浊的屈光间质，而且可以解除玻璃体牵引，阻止劈裂腔进一步发展，有助于改善和稳定视功能。     

Clinicopathologic findings in anterior hyaloidal fibrovascular proliferation after diabetic vitrectomy

Two young patients (27 and 30 years old, respectively) with long-standing diabetes mellitus underwent vitreoretinal surgery for traction retinal detachment and vitreous hemorrhage. The postoperative course in each was characterized by early recurrence of the hemorrhage into the vitreous cavity, hypotony, and severe visual loss. Histopathologic examination of both operated on eyes showed anterior extraretinal fibrovascular proliferation extending along the anterior hyaloid to the posterior lens surface, causing traction detachments of the peripheral retina and ciliary body. The vessels originated from the anterior retina. There was no evidence of excess fibrous tissue at the well-healed sclerotomy wounds.     

Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage

PURPOSE: To determine visual outcomes and the incidence of retinal detachment in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. DESIGN: Retrospective consecutive noncomparative interventional case series. PARTICIPANTS: Thirty-six eyes (15 right eyes and 21 left eyes) of 34 patients (18 female and 16 male) ranging in age from 42 to 94 years. Mean follow-up was 14 months. METHODS: A comparison of the best-corrected initial visual acuities versus final visual acuities after spontaneous resolution of vitreous hemorrhage or surgical intervention. The number of eyes that were found to have retinal tears or that had a rhegmatogenous retinal detachment develop was documented. Logarithm of the minimum angle of resolution-converted visual acuities was used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by Student's t test. MAIN OUTCOME MEASURES: Final mean visual acuities, number of eyes with at least one retinal tear, location of retinal tears, number of eyes that had retinal detachment develop, and the number of eyes repaired with scleral buckling surgery and/or pars plana vitrectomy. RESULTS: Twenty-four of 36 eyes (67%) were found to have at least one retinal break (range, 0-4 breaks), with 88% of breaks located in the superior retina. Eleven eyes (31%) had more than one retinal break. Fourteen of 36 eyes (39%) had a rhegmatogenous retinal detachment develop that was repaired with pars plana vitrectomy and scleral buckling. An additional 14 eyes (39%) underwent vitrectomy for nonclearing vitreous hemorrhage. The incidence of retinal detachment in eyes with a history of retinal detachment in the contralateral eye was 75% (P = 0.04). Seven of 14 eyes (50%) with retinal detachment had coexisting proliferative vitreoretinopathy. Most retinal breaks and detachments occurred in emmetropic or myopic eyes. For all 36 eyes the mean preoperative visual acuity was 20/1233, and the mean final visual acuity was 20/62 (P < 0.0001). Eyes that had a macula-off retinal detachment develop had worse final visual outcomes (20/264; P = 0.01), as did eyes that had proliferative vitreoretinopathy develop (20/129; P = 0.04). CONCLUSIONS: Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus-obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow-up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.     

玻璃体切割手术治疗不同类型玻璃体积血的临床研究

目的:观察不同原因导致玻璃体积血玻璃体切割的疗效及年龄等相关因素对玻璃体切割手术疗效影响。 方法:回顾性分析76例通过玻璃体切割手术治疗的玻璃体积血患者76眼的资料,按玻璃体积血原因、发病年龄和玻璃体积血时间分组,并进行统计学分析。 结果:在导致玻璃体积血原因中,糖尿病性视网膜病变（增生性）患者31例(41%),孔源性视网膜脱离24例(32%),视网膜分支静脉阻塞10例(13%),视网膜中央静脉阻塞3例(4%)。视网膜血管炎2例(3%),眼球钝挫伤2例(3%),单纯玻璃体积血2例(3%),增生性玻璃体视网膜病变1例(1%),息肉样脉络膜血管病变1例(1%)。各年龄组病因构成存在统计学差异（χ2=21.89,P<0.01）。年龄<45岁的青年组中,有26例,孔源性视网膜脱离导致玻璃体积血患者最多,共11例,占42%。年龄在45~59的中年组中,有19例,孔源性视网膜脱离导致玻璃体积血患者最多,共9例,占47%。年龄>60的老年组中,有31例,糖尿病性视网膜病变（增生性）导致玻璃体积血患者最多,共24例,占77%。在玻璃体积血时间分组中,各时间组术后视力存在统计学差异（χ2=2037,P<001）。1mo组共26例,术后视力主要为>0.3,共13例,占50%。2mo组共24例,术后视力主要为0.1~0.3,共10例,占42%。3mo组共11例,术后视力主要为0.01~0.09,共5例,占45%。>3mo组共15例,术后视力0.01~0.09和0.1~0.3,各6例,分别占40%。 结论：糖尿病性视网膜病变（增生性）、孔源性视网膜脱离和视网膜分支静脉阻塞是导致玻璃体积血的主要原因。玻璃体切割手术治疗玻璃体积血安全有效,可以在一定程度上提高患者视力。玻璃体积血患者在1~2mo内手术,疗效较好。     

Outcomes of vitreoretinal surgery for complications of branch retinal vein occlusion

OBJECTIVE: To investigate outcomes of vitreoretinal surgery for complications of branch retinal vein occlusion (BRVO). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The medical records of all patients who underwent vitreoretinal surgery for complications of BRVO at Bascom Palmer Eye Institute between January 1, 1991 and December 31, 1998 were reviewed. Thirty-six eyes from 36 consecutive patients were identified. MAIN OUTCOME MEASURES: Visual acuity outcomes include preservation of preoperative visual acuity and visual acuity greater than or equal to 20/40, 20/200 and 5/200. When preoperative retinal detachment was present, the anatomic outcome assessed was complete retinal attachment. Postoperative event rates of retinal detachment, vitreous hemorrhage, epiretinal membrane (ERM), and cataract were tabulated. All outcomes were assessed at 6 months. RESULTS: Surgical indications included nonclearing vitreous hemorrhage (17 patients), traction retinal detachment involving the macula (15), and ERM (4). Mean follow-up was 19 months. Preoperatively, best-corrected vision was greater than or equal to 20/200 in 19/36 (53%) eyes. Six months postoperatively, best-corrected vision was greater than or equal to 20/40 in 12/36 (33%) eyes, greater than or equal to 20/200 in 27/36 (75%) eyes, and greater than or equal to 5/200 in 31/36 (86%) eyes. Postoperative complications included retinal detachment (2/36; 6% eyes), ERM (3; 8%), vitreous hemorrhage (2; 6%), suprachoroidal hemorrhage (1; 3%), central retinal vein occlusion (1; 3%), and central retinal artery occlusion (1; 3%). Clinical features associated with better visual outcome include better preoperative visual acuity (P: = 0.05), absence of preoperative afferent pupillary defect (P: = 0.01), and absence of preoperative macular edema (P: = 0.08). CONCLUSIONS: Following surgery, retinal attachment and improved visual acuity were achieved in the majority of patients. Pre-existing pathology and postoperative complications may limit final vision in eyes with BRVO.     

玻璃体手术和眼内光凝治疗伴玻璃体积血和新生血管膜的视网膜静脉阻塞

目的评估玻璃体手术和眼内光凝治疗伴玻璃体积血、新生血管膜或牵拉性视网膜脱离的视网膜静脉阻塞（ｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＲＶＯ）的疗效。方法复习连续的３７例ＲＶＯ患者经玻璃体手术和眼内光凝治疗的３８只眼临床资料。视网膜分支静脉阻塞（ｂｒａｎｃｈｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＢＲＶＯ）１９例２０只眼，视网膜中央静脉阻塞（ｃｅｎｔｒａｌｒｅｔｉｎａｌｖｅｉｎｏｃｃｌｕｓｉｏｎ，ＣＲＶＯ）１８例１８只眼。结果手术中确认２７只眼有新生血管膜，２３只眼有牵拉性视网膜脱离。手术后３４只眼视力改善，占８９．５％，其中２２只眼有０．１以上的视力。４只眼视力未变。ＣＲＶＯ组病史较长，手术后视力改善较少。结论玻璃体手术和眼内光凝能改善多数伴有玻璃体积血、新生血管膜和牵拉性视网膜脱离的ＲＶＯ眼预后。     

Vitrectomy in retinal detachment caused by diabetic retinopathy

We reviewed the surgical results obtained in 23 eyes that underwent vitrectomy for diabetic traction retinal detachment. Retinal reattachment was obtained in 75% of eyes, however the functional results were modest, owing to retinal changes related to diabetic retinopathy and/or longstanding macular detachment. Ambulatory vision was obtained in 60% of eyes. 8 eyes (40%) had final visual acuity of 1/20 or better. Four preoperative clinical findings were associated with a poor prognosis = absence of scatter retinal photocoagulation, dense vitreous hemorrhage, iris neovascularization and preoperative visual acuity reduced to "light perception". Iatrogenic retinal breaks were also associated with a poor prognosis.     

Vitrectomy for diabetic traction retinal detachment using the multiport illumination system

OBJECTIVE: To examine the visual and anatomic results of bimanual vitrectomy surgery with the multiport illumination system (MIS) in eyes with advanced diabetic traction retinal detachment. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-seven consecutive eyes in 62 patients having vitrectomy with the MIS. METHODS: During surgery, the vitreous, the posterior hyaloid membrane, and fibrovascular proliferative tissue were removed by using bimanual dissection made possible by the MIS. MAIN OUTCOME MEASURES: Retinal reattachment rate, visual function, and postoperative complications were compared with previously published series of vitrectomy for diabetic traction retinal detachment. RESULTS: With a minimum of 6 months of follow-up, complete retinal reattachment was achieved in 62 eyes (93%), and macular attachment was achieved in all 67 eyes. Vision was stabilized or improved in 51 eyes (72%), and 5/200 vision was achieved in 47 eyes (70%). No unique complications, such as incision-related retinal tears, occurred. CONCLUSION: MIS allows bimanual surgery during vitrectomy for diabetic traction retinal detachment, with good visual and anatomic results.