A comparative study of 23 G vitrectomy and bimanual surgery in the management of epiretinal membranes in diabetic eyes

Abstract

PurposeThe purpose of the study was to compare the anatomical and functional outcome of the use of high-speed 23 G vitreous cutters shaving versus bimanual surgery in the management of epiretinal membranes (ERMs) in eyes with diabetic tractional retinal detachment (TRD).DesignProspective comparative double-blind study.SettingModern Ophthalmology Center, Alexandria, Egypt.Patients and methodsThe study was conducted on 60 eyes with diabetic TRD, divided blindly into two equal groups. Informed consent was obtained from all patients before participation in the study. Group I was operated upon with the Twinac cutter on Oertli OS3 NovitreX using the foot-controlled peristaltic pump. Group II was operated upon with a chandelier light using twinlight on BrightStar. The ERM was operated upon using curved 23 G scissors and end-gripping forceps. All eyes were followed up for 6 months after surgery.ResultsComplete removal of ERM was achieved in 20 (66.7%) eyes and 30 (100%) eyes, iatrogenic breaks in 10 (33.4%) eyes and five (16.7%) eyes, postvitrectomy bleeding in five (16.7%) eyes and two (6.7%) eyes, retinal tamponade was not needed in six (20%) eyes and eight (26.7%) eyes, in groups I and II, respectively. There was significant difference between the two groups in complete removal of ERM, use of gas or air as a tamponade, and use of silicone tamponade.ConclusionAlthough the advent of high-speed 23 G vitreous cutter facilitates dissection of ERM in eyes with diabetic TRD, bimanual surgery is associated with statistically significant more complete removal of ERM, more use of temporary tamponade as gas or air, and less use of silicone oil.