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Ehsan Rahimy, John D. Pitcher, III, Christopher J. Gee, Steven D. Schwartz, Jean-Pierre Hubschman; Diabetic Tractional Retinal Detachment Repair by Vitreoretinal Fellows in a County Health System. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2628.
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© ARVO (1962-2015); The Authors (2016-present)
To study preoperative characteristics, complications, and outcomes of pars plana vitrectomy (PPV) for tractional retinal detachment (TRD) repair secondary to proliferative diabetic retinopathy as performed by vitreoretinal fellows over the course of a two-year training program.
Consecutive retrospective review of all patients surgically treated for diabetic TRD at Olive View-UCLA County Hospital between December 2008 and December 2010.
62 eyes (57 phakic, 5 pseudophakic) of 58 patients were studied, with a mean age of 48 ± 9 years old (range 26-63 years), and mean preoperative hemoglobin A1c of 8.4 +1.9%. TRD was diagnosed by dilated fundus exam (33 eyes), B-scan ultrasound (24 eyes), or intraoperatively (5 eyes), and involved the macula in 55 eyes. Surgical indications were TRD (12.9%), tractional-rhegmatogenous retinal detachment (11.3%), and TRD with vitreous hemorrhage (75.8%). Prior panretinal photocoagulation had been performed in 34 eyes (54.8%), and vitreous hemorrhage (VH) was present in 55 eyes (88.7%) at the time of surgery. Preoperative intravitreal bevacizumab was administered up to two weeks before surgery in 8 cases, and did not increase the risk of postoperative rhegmatogenous retinal detachment (RRD) (p=1.0). Silicone oil tamponade at the end of the initial operation was utilized in 16 cases (25.8%). After mean follow-up of 11.2 months (range 1-32 months), anatomic success was achieved in 56 eyes (90.3%). Overall mean logMar visual acuity (Va) improved from 2.0 ± 0.5 to 1.4 ± 0.8. Postoperative Va improved in 33 eyes (53.2%), was unchanged in 11 eyes (17.7%), and decreased in 18 eyes (29%). Postoperative complications included secondary RRD 17.7% (11 eyes), early VH (<1 week postop) 16.1% (10 eyes), delayed VH (>3 months postop) 4.8% (3 eyes), and neovascular glaucoma 8% (5 eyes). Mean surgery duration was 153 ± 54 minutes. Primary successful TRD repairs lasted a similar amount of time compared with those resulting in secondary RRD (157 vs. 137 minutes, p=0.26), and patient's phakic status was not predictive of the risk for developing RRD (p=1.0). First year fellow surgeries lasted nearly as long as second year fellow cases (159 vs. 146 minutes, p=0.36).
Patients with diabetic TRD present to county hospitals at younger ages with more advanced disease. Final anatomic success of surgeries performed by vitreoretinal fellows in this setting is comparable to other series, but the increased incidence of postoperative complications may be due to the complex retinal pathology encountered in this patient population. Duration of fellowship training does not appear to be related to the rate of secondary RRD, and surgery times are comparable between junior and senior fellows.
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