Abstract
PurposeTo examine outcomes of 23-gauge (23G) pars plana vitrectomy (PPV) for complex diabetic tractional retinal detachment (TRD) in Chicago’s Cook County Health and Hospitals System (CCHHS).Materials and methodsThis is a retrospective noncomparative study of diabetic TRD cases that underwent PPV at CCHHS. Primary retinal reattachment rate, visual function, and postoperative complications were analyzed.ResultsSixty nine consecutive cases were included. Primary reattachment and final attachment were achieved in 68/69 eyes (98.6%). Secondary retinal detachment was noted in 1 eye (1.4%). Vitreous hemorrhage requiring repeat PPV developed in 5 eyes (7.2%) and reoperation due to other complications was required in 4/69 eyes (5.8%). Perfluoropropane (C3F8) gas tamponade was used in 91.3% of eyes and silicone oil in 8.7% of eyes. Mean LogMAR visual acuity significantly improved from 1.84 ± 0.61 to 0.93 ± 0.66, (P<0.0001). Vision was stabilized or improved in 66 eyes (95.7%). Visual acuity of 20/200 or better was achieved in 49/69 eyes (71.0%) and 20/50 or better in 16/69 eyes (23.2%).ConclusionsEven in patients with severe and advanced diabetic TRD pathology and unique demographics as seen in CCHHS, modern vitrectomy techniques can provide excellent anatomical and visual outcomes.
Highlights
Tractional retinal detachment (TRD) represents one of the most severe complications and a major cause of vision loss in patients with proliferative diabetic retinopathy (PDR)[1]
Vitreous hemorrhage requiring repeat pars plana vitrectomy (PPV) developed in 5 eyes (7.2%) and reoperation due to other complications was required in 4/69 eyes (5.8%)
Diabetic TRD is repaired with pars plana vitrectomy (PPV), which allows for simultaneous visualization and manipulation of the retina[3]
Summary
Tractional retinal detachment (TRD) represents one of the most severe complications and a major cause of vision loss in patients with proliferative diabetic retinopathy (PDR)[1]. An ischemic retina secretes locally active cytokines, such as vascular endothelial growth factor and connective tissue growth factor, which lead to neovascularization and connective tissue formation in the proliferative stage of diabetic retinopathy. This fibrovascular proliferation grows into the vitreoretinal interface and may contract, potentially resulting in TRD[2]. The surgical repair of diabetic TRD is among the most challenging surgeries for a vitreoretinal specialist due to the friable nature of the ischemic retina and the presence of extensive fibrovascular membranes[5]. Despite the difficulty of repair, recent advancements in vireoretinal surgery, including smaller gauge instruments, wide angle viewing systems, use of tamponade, self-retaining endoillumination, and the development of medications targeting vascular endothelial growth factor, have greatly improved outcomes in complex TRD cases [6,7,8,9]
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