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Sayeeda Fatima, Kevin Rosenberg, Asheesh Tewari; Surgical Outcomes for Tractional Retinal Detachments Secondary to Proliferative Diabetic Retinopathy in the “Modern Vitrectomy Era”. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5091.
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Traditional data from the 1980s for the rate of recurrent vitreous hemorrhage (VH) following pars plana vitrectomy (PPV) for diabetic vitrectomy is 30-60% with approximately 38% requiring reoperation. There have been improvements in vitrectomy instrumentation and technique, however. The purpose of this study is to determine the rates of re-bleed, reoperation, and retinal reattachment following small gauge vitrectomy surgery for tractional retinal detachment (TRD) from proliferative diabetic retinopathy (PDR).
A retrospective, single-surgeon consecutive case series analysis of patients that underwent PPV for primary diagnosis of TRD secondary to PDR was performed. Exclusion criteria included: TRD secondary to a non-diabetic cause, previous history of retinal surgery, follow up period of less than 3 months. Data recorded included gauge used, lens status, recurrent hemorrhage and re-operation rates and retinal anatomic status at most recent office visit.
A total of 67 eyes with TRD secondary to PDR were included in the study with a mean follow-up of 18 months. The majority of the cases had been operated on using a 23 gauge system (94%). At the time of the surgery, 44 (66%) of the eyes were pseudophakic and 23 (34%) were phakic. Overall, 62 (92.5%) of the eyes were successfully reattached; 5 (7.5%) eyes required reoperation for a recurrent retinal detachment and/or recurrent vitreous hemorrhage (3% and 4.5% respectively). Among the pseudophakic group, 3 (6.8%) eyes required reoperation; of the phakic group, 2 (8.7%) eyes required reoperation.
In this study, the rate of reoperation was 7.5% compared to the previously reported rate of reoperation of 38%. This low rate may be attributed to several factors including improvement in surgical technique, rendering the patient pseudophakic at or before surgery and the use of small gauge vitrectomy systems. Most of the patients were pseudophakic at the time of initial surgery. Although no statistically significant difference was observed in the rate of reoperation between pseudophakic (6.8%) and phakic (8.7%) patients, pseudophakia likely allowed a more complete anterior vitrectomy, thus decreasing the rate of recurrent hemorrhage.
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