Surgical outcomes of 25-gauge pars plana vitrectomy for diabetic tractional retinal detachment

Dikopf, Mark S.; Patel, Kunal; Setlur, Vikram; Lim, Jennifer I.

doi:10.1038/eye.2015.126

Cited by 26 publications

(38 citation statements)

References 29 publications

(52 reference statements)

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“…The incidence of recurrent VH in PDR was reported in 13-54% of cases [4][5][6][7]; in our study this incidence was 11%.…”

Section: Discussionmentioning

confidence: 63%

“…In the study by Quamar the re-TRD was in 50%, which were successfully treated by PPV without the use of an ocular tamponade in 92% [7].…”

Section: Discussionmentioning

confidence: 99%

“…Visual improvement was observed in 60% of patients and was more pronounced in the VH group. In a study by Quamar VA improved in 75% of patients after PPV without tamponade [7].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

Borowicz

Nowakowska²,

Koman³

et al. 2017

Ophthalmology J

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introduCtion. The aim of our study is to describe the anatomical and functional results of pars plana vitrectomy (PPV) among diabetic patients treated due to tractional retinal detachment (TRD) or non-clearing vitreous haemorrhage (VH). MateriaLs and Methods. A retrospective analysis was made of clinical data of 45 eyes treated with 23G PPV for TRD (17 eyes) or VH (28 eyes). Preoperative and final visual outcomes and postoperative complications were recorded. The mean follow-up period was 12 months. resuLts. The postoperative visual acuity (VA) improved significantly in 60% of eyes, but remained unchanged or was worse in 40%. Improvement of VA was more pronounced in the VH group. PPV was performed with silicone oil tamponade in 66.5%, air tamponade in 29%, and gas tamponade in 4.5%. Postoperative complications included: retinal re-detachment (seven eyes), secondary glaucoma (nine eyes), and recurrent VH (two eyes). ConCLusions. PPV is an effective treatment method of complications of severe proliferative diabetic retinopathy inter alia the TRD and VH. Because surgical management of TRD and VH is demanding, anatomical and functional results are limited by complications.

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“…The incidence of recurrent VH in PDR was reported in 13-54% of cases [4][5][6][7]; in our study this incidence was 11%.…”

Section: Discussionmentioning

confidence: 63%

“…In the study by Quamar the re-TRD was in 50%, which were successfully treated by PPV without the use of an ocular tamponade in 92% [7].…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

Borowicz

Nowakowska²,

Koman³

et al. 2017

Ophthalmology J

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“…Since its first description over a decade ago, 1 minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care 2,3 even in complex retinal pathologies such as tractional diabetic retinal detachment [4][5][6][7][8] or advanced proliferative vitreoretinopathy (PVR). 9 Meanwhile, the combination of MIVS and small-incision phacoemulsification has become the standard of care in phakic eyes with coexisting cataract and retinal pathology 10 allowing better access to the vitreal base and faster visual recovery without requiring a second operation after cataract progression.…”

Section: Introductionmentioning

confidence: 99%

“…17,22 To avoid having to switch sclerotomy diameters intraoperatively and optimize outcomes, some authors considered mixing different sizes of small gauge vitrectomy depending on the specific surgical needs. 5,6,23 The performance of new developments in vitrectomy, namely smaller gauge instrumentation, must be compared to existing technologies with regard to vitrectomy duration and safety outcomes. The latter are particularly difficult to assess if the outcome affects macular structure rather than retinal stability, but in these cases, early recovery of visual acuity may be a qualified indicator of surgical trauma.…”

Section: Introductionmentioning

confidence: 99%

<p>Hybrid 23/27 Gauge Vitrectomy – Combining the Charm of 27G with the Efficacy of 23G</p>

Garweg

Ouassi

Pfister

2020

OPTH

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Background: Minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes. Methods: This retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra-and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma. Results: Surgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4 ±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; p=0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy. Conclusion: In this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.

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Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

et al. 2023

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ImportanceTractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy (PPV) is the treatment of choice for TRD.ObjectiveTo determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD).Data SourcesMEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened.Study SelectionEligible studies were those published in English, those reporting outcomes of PPV for dTRD, and those that included more than 25 eyes and with a minimum follow-up of 3 months.Data Extraction and SynthesisPreferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction/synthesis were followed, and the National Institute for Health quality assessment tool was used to assess risk of bias. Study eligibility was determined independently by 2 reviewers; data extraction was conducted by 1 reviewer and entries checked for accuracy by another. Data were pooled using a random-effects model.Main Outcomes and MeasuresMain outcomes included rate of failure of retinal reattachment following 1 surgery and final visual acuity (VA). The association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated.ResultsOf the 406 studies identified, 38 (3839 eyes) were eligible and included for analysis. Patients had a median (IQR) age of 52.2 (49.6-55.7) years. In the studies reporting patient sex (31 of 38 studies), 1441 were female individuals (50.1%). The overall failure rate of retinal reattachment after 1 surgery was 5.9% (95% CI, 1.4%-8.3%), and the mean final VA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71). People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P &lt;.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes.Conclusions and RelevanceResults of this systematic review and meta-analysis suggest that PPV was an effective strategy to achieve retinal reattachment in people with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Overall, final postoperative VA remains low, and patients should be counseled on the guarded prognosis of dTRD.

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Surgical outcomes of 25-gauge pars plana vitrectomy for diabetic tractional retinal detachment

Abstract: Purpose To evaluate the outcomes and complications of 25-gauge (G) pars plana vitrectomy (PPV) for repair of diabetic tractional retinal detachment (TRD).

Cited by 26 publications

References 29 publications

Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

<p>Hybrid 23/27 Gauge Vitrectomy – Combining the Charm of 27G with the Efficacy of 23G</p>

Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes

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