May 2007
Volume 48, Issue 13
ARVO Annual Meeting Abstract  |   May 2007
Anatomical and Functional Outcome of Diabetic Tractional Retinal Detachments
Author Affiliations & Notes
  • A. Hira
    UMDNJ, Newark, New Jersey
  • S. Akbari
    UMDNJ, Newark, New Jersey
  • N. Bhagat
    UMDNJ, Newark, New Jersey
  • Footnotes
    Commercial Relationships A. Hira, None; S. Akbari, None; N. Bhagat, None.
  • Footnotes
    Support None.
Investigative Ophthalmology & Visual Science May 2007, Vol.48, 5755. doi:
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      A. Hira, S. Akbari, N. Bhagat; Anatomical and Functional Outcome of Diabetic Tractional Retinal Detachments. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5755.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose:: To assess functional and anatomical outcomes of surgical intervention for diabetic tractional retinal detachments (TRD).

Methods:: Retrospective review of eyes with diabetic TRD that underwent pars plana vitrectomy (PPV) between July 2001 and June 2005 by 1 surgeon, NB. Eyes that had undergone initial PPV by another surgeon were excluded. Eyes with vitreous hemorrhage (VH) without RD were also excluded. A positive functional outcome was defined as better than 2 lines improvement on the Snellen chart. A positive anatomic outcome was defined as no recurrent RD.

Results:: One hundred and eighteen eyes of 101 patients (mean age=51.1 years) were identified with TRD who underwent PPV with a wide angle viewing system. The macula was involved in 84 eyes (71%). Mean follow-up was 14.6 months. Sixty-eight patients were males and 50 were females. Twenty-two patients had type 1 diabetes mellitus (DM) and 96 had type II DM. Ninety-nine eyes underwent PPV once, 15 twice, 2 three times, and 1 four times (mean #PPV=1.2). Mean preoperative VA in logMAR increased from 2.39 to 1.85 within 6 months (p=0.001). In all but the C3F8 subgroup, statistically significant VA improvement was noted. Preoperative IOP increased from a mean of 15.1 to 25.7 mm Hg on POD #1 (p=0.000) and 17.6 on POD #2-10 (p=0.004). Progressive lens opacification was noted in 52 of 107 phakic eyes post-operatively. Of these, 17 eyes needed cataract surgery within 6 months after PPV; 10 needed CE surgery within 1 year; 1 needed CE surgery within 2 years. The following tamponade was used during the initial PPV: none (4), air (35), SF6 (23), C3F8 (30), silicone oil (SO) (26). Two eyes had the SO removed within 6 months. A positive functional outcome was seen in 47 (39.8%) patients and a positive anatomical outcome was seen in 106 (89.8%) patients. The following preoperative variables were associated with a negative visual outcome: age>50 (p=0.015), macular involvement (p=0.023), VH (p=0.004), cataract (p=0.010), and glaucoma (p=0.040). The following postoperative complications were noted: VH (n=27), cataract progression (n=52), recurrent RD (n=12), ERM (n=11), IOP>21 (n=80), hyphema (n=1), NVE (n=1), retinal hole (n=1), VMT (n=1), NVI (n=5), CNIII palsy (n=1), SRF (n=2), retinal ischemia (n=2), glaucoma (n=1), pseudohole (n=1), MH (n=1). VH resolved spontaneously in 22 patients and 5 patients needed repeat PPV.

Conclusions:: 40% of patients with TRD (70% macula involving) had improvement of at least 2 lines of VA with PPV. The anatomic outcome with one surgery was 90%. Type of tamponade used had no significant difference in the anatomic outcome; however, for the functional outcome analysis, patients in the C3F8 group did poorer than the other tamponade groups.

Keywords: retinal detachment • vitreoretinal surgery • diabetes 

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