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L.J. Baur, H. Llacer, J. Mackiewicz, A.M. Joussen; Functional Outcome for Vitreous Surgery in Diabetic Patients. A Retrospective Analysis of 200 Consequent Eyes . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1480.
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The present study was initiated to assess acuity improvement following surgery for diabetic retinopathy.
The course of 200 consecutive eyes undergoing surgery for diabetic retinopathy were retrospectively reviewed. Surgery was performed for vitreus hemorrhage (92/200), PDR(51/200), maculopathy (9/200), tractive detachment of the macula (19/200), tractive detachment of the retina without maculadetachment (14/200), hemorrhagic secondary glaucoma (15/200). Silicone–oil was used in 105 eyes and removed during the follow–up in 55 eyes. Changes in visual acuity in comparison to the preoperative value were assessed 12 months after the initial surgery.
The mean values visual acuity improved after surgery for patients with PDR with vitreous hemorrhage (1.64 vs. 0.96 logMar, p 0.05). Eyes requiring silicone oil for endotamponade comprised 10 eyes with a macula–on detachment, 14 with a macula–off detachment, and 7 eyes with a hemorrhagic secondary glaucoma. 21 eyes operated on for PDR or maculopathy, and 29 for vitreous hemorrhage required silicone oil tamponade for intraoperative peripheral retinal complications. Out of the eyes requiring silicone tamponade, 37 were phacic, and 44 were aphacic or pseudophacic. Visual acuity did not significantly improve after silicone tamponade with or without removeal thereof (1.83 vs. 1.75 logMar; and 1.58 vs. 1.48 logMar, respectively (p> 0.05; p>0.05). Surgery for diabetic maculopathy was not associated with an improvement of visual acuity (1.18 vs. 1.18 logMar). Despite of surgery, visual acuity in patients presenting with rubeotic glaucoma dropped during the follow–up of 12 months (1.2 vs. 2.01 logMar).
This study confirms a long–term improvement in visual acuity can be achieved in eyes with PDR and vitreous hemorrhage. Preexisting ischemia may be a reason why eyes with tractional detachment are unlikely to functionally benefit. Similarly, the requirement for long–term endotamponade with silicone oil indicates a severe preexsisting preoperative retinal pathology with reduced changes for functional improvement after surgery.
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