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