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Kevin Patel, Mark Dikopf, Vikram Setlur, Jennifer Lim; Surgical Outcomes of 25-Gauge Vitrectomy for Diabetic Tractional Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3323.
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To evaluate the outcomes and complications of 25-gauge pars plana vitrectomy (PPV) for repair of diabetic tractional retinal detachments.
A retrospective review was performed of all operations for a single surgeon (JIL) from July 2007 to October 2012. Eyes with tractional retinal detachments due to proliferative diabetic retinopathy were included. Outcome measures included visual acuity and anatomic success rates with a minimum follow-up of 3 months.
Sixty-three eyes of 49 patients were included in the study. All eyes underwent 25-gauge PPV for repair of diabetic tractional retinal detachment. Mean age at the time of surgery was 47.7 years. Mean follow-up was 454.3 days. Forty-six eyes (73.0%) had vitreous hemorrhage present pre-operatively. Forty-two eyes (66.7%) had a rhegmatogenous component to their detachment. The type of tamponade used was as follows: 20 eyes (31.7%) with balanced salt solution, 19 eyes (30.2%) with SF6 gas, 21 eyes (33.3%) with C3F8 gas, and 3 eyes (4.8%) with silicone oil. The average visual acuity improved from pre-operative logarithm of the minimum angle of resolution (logMAR) of 1.58 to a post-operative logMAR of 0.56 (p < 0.0001; six eyes could not be evaluated for change in visual acuity as their pre- or post-operative visual acuity was light perception or worse, thus, could not be converted to logMAR visual acuity). Primary reattachment was achieved in 58 eyes (92.1%). Five eyes (7.9%) redetached; of these, 4 were reattached with a total of 5 surgeries. Attachment at the final visit was achieved in 62 eyes (98.4%). Complications included recurrent vitreous hemorrhage in 14 eyes (22.2%), recurrent vitreous hemorrhage requiring repeat PPV in 6 eyes (9.5%), and epiretinal membrane requiring repeat PPV in 1 eye (1.6%). Three eyes (4.8%) had no light perception vision at their final visit but were attached anatomically.
Twenty-five gauge PPV for tractional retinal detachment secondary to proliferative diabetic retinopathy is an effective procedure for this complex disease. Complication rates are low and comparable to those reported in 20- and 23-gauge vitrectomy.
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