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Christina Y Weng, Salman A. Rahman, Beena M. Shah, Mara A. Rivera; Visual and Anatomic Outcomes of Diabetic Tractional Retinal Detachment Repair in a County Health System. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2822.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze visual and anatomic outcomes of diabetic tractional retinal detachment (DTRD) repairs performed by trainees in a large county hospital.
Retrospective chart review of patients who underwent primary or recurrent DTRD repair from 2014-2016. Primary outcome was visual acuity (Va); secondary outcomes included complication rates at 6 months postoperatively. Unpaired and paired t-tests were used to identify differences in the means. Statistical significance was defined as p-value <0.05.
139 patients (average age 49.9 years) were included. Mean preoperative visual acuity (Va) was logMAR 1.59 ± 0.50. The majority of cases were primary repairs (83%) and macula-involving (66%). More than half received previous panretinal photocoagulation (PRP) (63%) and preoperative intravitreal anti-VEGF (54%).Many patients required silicone oil tamponade (45/139); C3F8 was used in 56 patients, SF6 was used in 12 patients, and 31 patients received air/no tamponade. Fifteen eyes (11%) eyes required a retinectomy. One-third (31%) of phakic eyes received cataract extraction +/- intraocular lens implantation concurrently or in the postoperative period.Mean overall postoperative Va was logMAR 1.56 ± 0.70 (no significant difference from preoperative Va). The only factor which seemed to affect outcome was preoperative anti-VEGF status; patients who received anti-VEGF had a final Va of logMAR 1.38 ± 0.74 vs. 1.76 ± 0.61 amongst those who had not (p = 0.0016, no difference in preoperative Va between the two groups). No significant difference between pre- and postoperative Va was found in subgroup analyses stratifying patients by macula involvement, primary vs. recurrent repair, retinectomy presence, pseudophakic only, baseline HbA1c, history of PRP, or surgeon experience level. The most common postoperative complications were vitreous hemorrhage (30/139 eyes), redetachment (22), and neovascular glaucoma (7).
Although no significant overall difference in preoperative and postoperative Va was seen in this cohort undergoing DTRD repair, preoperative anti-VEGF correlated with a significant improvement in postoperative Va in a subgroup analysis. Despite a complex level of pathology in this patient population and trainees performing the surgeries, surgical success and complication rates were comparable to reports in the literature.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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