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JJ Scherer, TR Friberg, M Ohji, Y Tano; Frequency of Surgeon Reported Corneal Epithelial Debridement During Diabetic Vitrectomy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):556.
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Purpose: During vitreous surgery, corneal clarity is paramount to achieve the surgical goal. In particular, corneal edema can diminish the surgeon's view and require that the corneal epithelium be debrided for visualization. We surveyed 55 retinal surgeons to determine the average frequency of epithelial debridement during diabetic vitrectomy across a wide range of practices. Methods: A survey was sent to active vitreoretinal surgeons to retrospectively determine by self-reporting the approximate number of diabetic vitrectomies that they performed annually. Additionally, the percentage of those cases which required epithelial debridement, which by definition produces an epithelial defect that may lead to other clinical difficulties in the post operative period, was determined. We did not take into consideration the duration or complexity of each case, but chose instead to determine a representative frequency of a large number of surgical cases. Furthermore, we sought to determine whether the choice of contact lens had an influence on debridement frequency. Results: The frequency of epithelial debridement was 17.4% (+/- 19.0%) across 8,002 vitrectomies, with a range from 0 to 90%. We found a significantly higher frequency of corneal epithelial debridement in cases where infusion lenses were used (23.5%), compared to those cases where sew-on or floating lenses were utilized (12.1%), p<0.05, n = 3,318. Conclusion: While historically epithelial debridement in diabetics was almost routine, debridement currently does not appear to be necessary in a large number of cases. Use of non-irrigating lenses may well reduce the necessity for epithelial removal.
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