Abstract
BackgroundThe recent advancement in the management of chronic renal failure (CRF) has significantly increased the longevity of the patients, which increase the incidence of severe vitreoretinopathy. The vitrectomy is highly risky in this particular group of patients due to their systemic comorbidity. The timing surgical intervention is usually delayed because of the systemic conditions. This study is to evaluate the safety and effectiveness of 25-guage vitrectomy for severe vitreoretinopathy in the CRF patients.MethodsIn this retrospective study, 16 eyes of 16 CRF patients with severe vitreoretinopathy were undergone 25-guage vitrectomy in the department of Ophthalmology of the Second Hospital of Tianjin Medical University from February 2015 to April 2017. The visual outcome, complications and perioperative medical management were documented and analyzed.ResultsThe best-corrected visual acuity(BCVA)of fourteen eyes were lower than 20/200 preoperatively. Surgery duration ranged from 28 to 72 min, with a mean of 48.4 ± 13.6 min. During the surgery, 12 eyes were diagnosed with DR, while two them were complicated with tractional retinal detachment and one with branch retinal vein occlusion. Three eyes were diagnosed with branch retinal vein occlusion, and one eye was diagnosed with hypertensive retinopathy. Postoperative BCVA of six eyes ≥20/40, seven eyes ≥20/200, and three eyes < 20/200. BCVA of eight eyes improved more than three lines, three eyes improved two lines, and four eyes improved one line. BCVA decreased from hand movement to light perception in one patient who developed neovascular glaucoma two weeks after surgery.ConclusionIn chronic renal failure patients with severe vitreoretinopathy, the well-planned minimally invasive vitrectomy is effective and safe. Additionally, careful management of the perioperative systemic conditions is important to improve the visual acuity and quality of life as well.
Highlights
The recent advancement in the management of chronic renal failure (CRF) has significantly increased the longevity of the patients, which increase the incidence of severe vitreoretinopathy
CRF patients combined with severe vitreoretinopathy often have vitreous hemorrhage and tractional retinal detachment that can be treated by vitrectomy
Three eyes were diagnosed as branch retinal vein occlusion, and one eye was diagnosed as hypertensive retinopathy
Summary
The recent advancement in the management of chronic renal failure (CRF) has significantly increased the longevity of the patients, which increase the incidence of severe vitreoretinopathy. This study is to evaluate the safety and effectiveness of 25-guage vitrectomy for severe vitreoretinopathy in the CRF patients. The major etiologies of CRF include diabetic nephropathy, hypertensive renal arteriolar sclerosis, glomerulonephritis, renal interstitial disease, renal vascular disease, and inherited renal disease. These conditions can severely affect the overall health of patients. Given the complicated comorbid conditions of these patients, the surgery is highly risky. The recent advancement in minimal invasive vitrectomy effectively shortens the surgery duration and reduces the incidence of both intraoperative and postoperative complications. We used 25-gauge vitrectomy to treat severe vitreoretinopathy in patients with CRF and retrospectively analyzed and reported the clinical outcomes as below
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