Preliminary access of efficacy of vitreoretinal surgeries without endotamponade for diabetic tractional retinal detachment

Abstract

Objective To evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with diabetic tractional retinal detachment (DTRD).Methods The clinical interventional case series study included 104 patients (112 eyes) with DTRD,who were consecutively treated by pars plana vitrectomy without use of intraocular silicone oil or gas.Among the eyes,there were 6 eyes with iris neovascularization (INV),1 eye with neovascular glaucoma (NVG) and 50 eyes with macular retinal detachment.There were no pre-existing retinal holes or breaks prior to surgery nor any iatrogenie retinal breaks developed during vitrectomy.Cataract removal combined with intraoeular lens implant surgeries were performed on 15 eyes.Follow-up duration varied from 12 to 65 months (mean: 29 months).Results Subretinal fluid was completely absorbed within 2 months after surgery.In 107 eyes (95.54%),the retina reattached after surgery and remained attached till the end of follow-up period.Best corrected visual acuity (BCVA) improved in 79 eyes (70.53%),remained unchanged in 14 eyes (12.500%) and got worse in 19 eyes (16.79%).The BCVA improving rate was lower in the macular detached group (33 eyes/50 eyes,66.00% Vs 46 eyes/62 eyes,74.19%,χ2=0.89,P=0.344).No obviously aggravated opacity of lens was observed after vitreoretinal surgeries in the eyes without cataract surgeries.Seven (6.25%) eyes showed INV (5 new onset eyes),and none of them developed into NVG.In multivariate logistic regression,factors associated with postoperative rubeosis iridis were pre-existing rubeosis iridis I-adjusted odds ratio (OR)= 10.2],low preoperative BCVA (OR= 11.1) and low postoperative BCVA (OR = 16.7).Conclusions Vitreoretinal surgery for DTRD may not necessarily be combined with silicone oil or gas tamponade if there are no preoperative or intraoperative retinal breaks,and only using irrigation fluid could access a good long-term prognosis result. Key words: Diabetic retinopathy/surgery; Retinal detachment/surgery; Vitrectomy; Silicone oils/therapeutic use; Noble gases/therapeutic use