Transconjunctival Sutureless 23-gauge Vitrectomy for Diabetic Retinopathy. Review

Arumí, José García; Boixadera, Anna; Martínez-Castillo, Vicente; Corcóstegui, Borja

doi:10.2174/157339909787314194

Cited by 11 publications

(8 citation statements)

References 12 publications

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“…Surgery is used for advanced DR namely in situations presenting vitreous hemorrhage, retinal detachment, or extensive fibrous membranes [Mason et al, ]. Advances in vitreoretinal surgical instrumentation and technique enabling more effective removal of complex fibrovascular membranes has been enabling visual outcome improvement [Arumi et al, ]. However, the visual outcome after vitrectomy is unpredictable [Newman, ].…”

Section: Current Therapeutic Of Drmentioning

confidence: 99%

Angiogenesis and Inflammation Crosstalk in Diabetic Retinopathy

Capitão

Soares

2016

J of Cellular Biochemistry

263

190

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Diabetic retinopathy (DR) is one of the most prevalent microvascular complications of diabetes and one of the most frequent causes of blindness in active age. Etiopathogenesis behind this important complication is related to several biochemical, hemodynamic and endocrine mechanisms with a preponderant initial role assumed by polyol pathways, increment of growth factors, accumulation of advanced glycation end products (AGE), activation of protein kinase C (PKC), activation of the renin-angiotensin-aldosterone system (RAAS), and leukostasis. Chronic and sustained hyperglycemia works as a trigger to the early alterations that culminate in vascular dysfunction. Hypoxia also plays an essential role in disease progression with promotion of neovascularization and vascular dystrophies with vitreous hemorrhages induction. Thus, the accumulation of fluids and protein exudates in ocular cavities leads to an opacity augmentation of the cornea that associated to neurodegeneration results in vision loss, being this a devastating characteristic of the disease final stage. During disease progression, inflammatory molecules are produced and angiogenesis occur. Furthermore, VEGF is overexpressed by the maintained hyperglycemic environment and up-regulated by tissue hypoxia. Also pro-inflammatory mediators regulated by cytokines, such as tumor necrosis factor (TNF-α) and interleukin-1 beta (IL-1β), and growth factors leads to the progression of these processes, culminating in vasopermeability (diabetes macular edema) and/or pathological angiogenesis (proliferative diabetic retinopathy). It was found a mutual contribution between inflammation and angiogenesis along the process. J. Cell. Biochem. 117: 2443-2453, 2016. © 2016 Wiley Periodicals, Inc.

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Section: Current Therapeutic Of Drmentioning

confidence: 99%

Angiogenesis and Inflammation Crosstalk in Diabetic Retinopathy

Capitão

Soares

2016

J of Cellular Biochemistry

263

190

View full text Add to dashboard Cite

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“…The improvement in visual outcome achieved about 10 years ago mainly resulted from advances in vitreoretinal surgical instrumentation and technique enabling more effective removal of complex fibrovascular membranes [37]. Transconjunctival sutureless 23- or 25-gauge vitrectomy started to replace conventional 20-gauge technique and offers comparable safety and efficacy as well as reduced surgery times and faster rehabilitation of patients [38].…”

Section: Current Ophthalmic Therapeutic Optionsmentioning

confidence: 99%

New Diagnostic and Therapeutic Approaches for Preventing the Progression of Diabetic Retinopathy

Park

Roh

2016

Journal of Diabetes Research

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Diabetic retinopathy (DR) is a severe sight-threatening complication of diabetes mellitus. Retinal laser photocoagulation, antivascular endothelial growth factors, steroid therapy, and pars plana vitrectomy are now used extensively to treat advanced stages of diabetic retinopathy. Currently, diagnostic devices like ultrawide field fundus fluorescein angiography and the improvement of optical coherence tomography have provided quicker and more precise diagnosis of early diabetic retinopathy. Thus, treatment protocols have been modified accordingly. Various types of lasers, including the subthreshold micropulse laser and RPE-targeting laser, and selective targeted photocoagulation may be future alternatives to conventional retinal photocoagulation, with fewer complications. The new developed intravitreal medications and implants have provided more therapeutic options, with promising results.

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“…Its limited usage was due to several factors including excessive flexibility of the instruments that made some surgical maneuvers more difficult, low flow rates, less efficient cutters, and wound leakage-associated complications (postoperative hypotony and endophthalmitis) that were related to the sutureless closure of the ports. 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

“…The prominent ones are smaller incisions without peritomy, self-sealing sclerotomies that heal faster, diminished conjunctival scarring that allows repeat surgeries, decreased postoperative inflammation, and a decrease in induced astigmatism that may facilitate visual recovery. 9 , 11 , 13 , 16 Moreover, because the cutting tip is closer to the edge of the device, the vitrector facilitates segmentation, dissection, and removal of the fibrovascular membranes in PDR. 9 , 13 The smaller lumen diameter also improves fluidics, allowing for better fluid stability and less tissue movement or incarceration.…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 11 , 13 , 16 Moreover, because the cutting tip is closer to the edge of the device, the vitrector facilitates segmentation, dissection, and removal of the fibrovascular membranes in PDR. 9 , 13 The smaller lumen diameter also improves fluidics, allowing for better fluid stability and less tissue movement or incarceration. Better fluidics increase the safety of intraoperative maneuvers.…”

Section: Introductionmentioning

confidence: 99%

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Advantages of diabetic tractional retinal detachment repair

Sternfeld¹,

Axer‐Siegel²,

Stiebel‐Kalish³

et al. 2015

OPTH

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Purpose: To evaluate the outcomes and complications of patients with diabetic tractional retinal detachment (TRD) treated with pars plana vitrectomy (PPV). Patients and methods:We retrospectively studied a case series of 24 eyes of 21 patients at a single tertiary, university-affiliated medical center. A review was carried out on patients who underwent PPV for the management of TRD due to proliferative diabetic retinopathy from October 2011 to November 2013. Preoperative and final visual outcomes, intraoperative and postoperative complications, and medical background were evaluated. Results: A 23 G instrumentation was used in 23 eyes (95.8%), and a 25 G instrumentation in one (4.2%). Mean postoperative follow-up time was 13.3 months (4-30 months). Visual acuity significantly improved from logarithm of the minimum angle of resolution (LogMAR) 1.48 to LogMAR 1.05 (P,0.05). Visual acuity improved by $3 lines in 75% of patients. Intraoperative complications included iatrogenic retinal breaks in seven eyes (22.9%) and vitreal hemorrhage in nine eyes (37.5%). In two eyes, one sclerotomy was enlarged to 20 G (8.3%). Postoperative complications included reoperation in five eyes (20.8%) due to persistent subretinal fluid (n=3), vitreous hemorrhage (n=1), and dislocated intraocular lens (n=1). Thirteen patients (54.2%) had postoperative vitreous hemorrhage that cleared spontaneously, five patients (20.8%) required antiglaucoma medications for increased intraocular pressure, seven patients (29.2%) developed an epiretinal membrane, and two patients (8.3%) developed a macular hole. Conclusion: Patients with diabetic TRD can benefit from PPV surgery. Intraoperative and postoperative complications can be attributed to the complexity of this disease.

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Transconjunctival Sutureless 23-gauge Vitrectomy for Diabetic Retinopathy. Review

Cited by 11 publications

References 12 publications

Angiogenesis and Inflammation Crosstalk in Diabetic Retinopathy

Angiogenesis and Inflammation Crosstalk in Diabetic Retinopathy

New Diagnostic and Therapeutic Approaches for Preventing the Progression of Diabetic Retinopathy

Advantages of diabetic tractional retinal detachment repair

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