En Bloc Perfluorodissection for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy

Abstract

En bloc perfluorodissection (EBPD) is a surgical dissection technique that facilitates removal of epiretinal membranes and the posterior hyaloid. It is carried out by injecting perfluorocarbon liquid between the retina and the posterior hyaloid to separate the epiretinal tissues from the subjacent retina. The objective of this study was to describe the technique and to demonstrate the applicability of using EBPD during vitrectomy in eyes with tractional retinal detachment (TRD) in proliferative diabetic retinopathy (PDR). Prospective, interventional case series. Fifty-seven patients (eyes) with TRD in PDR participated in the study. The author performed EBPD in 57 eyes (consecutive patients) during vitrectomy for TRD in severe PDR. Mean age of the patients was 42 years (range, 23-84 years). Mean surgical time was 50 minutes (range, 40-75 minutes). The group of patients was followed up for a mean of 18 months (range, 8-26 months). Best-corrected visual acuity (BCVA), retinal status, and complications at the end of follow up. None of the patients have developed ocular hypertension or undue inflammation, and anatomic success-accompanied by visual improvement (> or =2 Early Treatment Diabetic Retinopathy Study [ETDRS] lines) in 70.1% (40/57)-occurred in 100% (57/57) of eyes. In 14 eyes (24.5%), BCVA remained stable, and in 3 eyes (5.2%), BCVA decreased (> or =2 ETDRS lines). Final BCVA was 20/50 or better in 25%, between 20/60 and 20/400 in 47%, and worse than 20/400 in 28%. Complications included phthisis bulbi in 1 (1.7%) eye, iatrogenic retinal breaks in 4 (7%) eyes, vitreous hemorrhage requiring another procedure in 4 (7%) eyes, and cataract in 15 (26.3%) eyes. This report demonstrates the applicability of using EBPD during vitrectomy in eyes with TRD in PDR.