Vitrectomy Using Continuous Infusion of Oxygenated Perfluorocarbons (ViCIOP) in Patients with Severe Proliferative Diabetic Retinopathy and Tractional Retinal Detachment. Anatomic and Visual Results

Abstract

Abstract: : Purpose: To describe and analyze anatomic and visual results obtained in patients that underwent vitrectomy using continuous infusion of oxygenated perfluorocarbons (ViCIOP) for tractional retinal detachment secondary to severe proliferative diabetic retinopathy. Methods: A prospective, non-comparative, longitudinal, and experimental study was conducted. Thirty eyes of 30 patients showing tractional retinal detachment involving the macula secondary to severe proliferative diabetic retinopathy were enrolled. All patients signed an informed consent approved by IRB and were operated using ViCIOP technique, in which balance saline solution was replaced by perfluorocarbon liquids (PFCLs) since the beginning of the procedure. Complete ophthalmologic examination, visual acuity measurement using the ETDRS, fundus photographs and corneal endothelial cell count were obtained and registered on baseline and at 1, 7, 15, 30, 60 and 90 days after surgical intervention. Intraocular tamponade was with silicone oil in all cases Results: Anatomical success was obtained in 100% cases, with complete reattachment of the retina and macular area with a minimum follow-up of 3 months. Initial visual acuity was 20/200 in 6 patients (20%) hand motion in 15 cases (50%) and light perception in 9 cases (30%). Final visual acuity at three month follow-up was 20/80 in 9 cases (30%), 20/100 in 3 (10 %), 20/200 in 6 ( 20%) 20/400 in 4 (13.33 %) 20/600 in 4 (13.33%), light perception in 3 (10%) and no light perception was the final result en 1 (3.33%) Visual acuity improved in twenty eyes, didn't change in six eyes and worsened in four eyes. No significant changes in endothelial cell count were observed Conclusions: Succesful anatomic and visual results suggest that using ViCIOP to treat tractional retinal detachment secondary to severe proliferative diabetic retinopathy is a useful technique for select patients since it allows maneuvers such as peeling, delamination, or segmentation and complete posterior hyaloid removal as well as effective endodiathermy and endophotocoagulation under exceptionally good viewing conditions due to physycal and chemical properties of PFCLs therefore increasing the effectiveness of the procedure. Further studies and longer follow up is needed to confirm this trends.

Keywords: vitreoretinal surgery • clinical (human) or epidemiologic studies: out • diabetic retinopathy