Abstract
Objective:To assess the visual outcome and complications of 25-gauge micro incision vitrectomy surgery (MIVS) in diabetic vitreous haemorrhage.Methods:This Quasi Experimental study was conducted at LRBT, Tertiary eye care hospital Karachi, from February 2012 to January 2013. Sixty eyes of sixty patients with uncontrolled type II diabetes mellitus (DM) were included. There were 43 (71.7%) males and 17 (28.3%) females. Age range was 40 – 60 years. All randomly selected patients underwent 25-gauge sutureless micro incision vitrectomy surgery for diabetic vitreous haemorrhage. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative complications. Follow ups were at one day, one week, one month, three months and six months post-operatively.Result:Best corrected visual acuity (BCVA) gradually improved in majority of subjects in each subsequent follow up visit. Preoperative visual acuity was 1.023 ±0.226 logMAR, which was improved after final follow up to 0.457±0.256 and P-value was < 0.001. Five patients developed recurrent vitreous haemorrhage during study period, one patient developed cataract (1.7%), one (1.7%) had ocular hypotony defined as intraocular pressure < 5 mmHg and one (1.7%) developed endophthalmitis.Conclusion:25-gauge micro incision vitrectomy surgery (MIVS) is an effective sutureless parsplana vitrectomy surgery which has good visual outcome in diabetic vitreous haemorrhage with minimum manageable complications.
Highlights
It has been found that prevalence of proliferative diabetic retinopathy (PDR) in Pakistan is 2.65–5%.1,2 One of the major causes of visual impairment in patients of proliferative diabetic retinopathy is vitreous haemorrhage but due to emergence of vitrectomy system and rapid advancement in surgical techniques for posterior segment pathologies there is dramatic recovery of visual acuity after surgery
The rationale of this study is to look postoperative visual outcome and complications after 25-gauge micro incision vitrectomy surgery in patients with diabetic vitreous haemorrhage
Post-operative complications are summarized in Table-II. These were managed on a case-tocase basis. Those who had recurrent vitreous haemorrhage were re-operated after a few months to clear the vitreous haemorrhage through 25 gauge micro incision vitrectomy surgery (MIVS)
Summary
It has been found that prevalence of proliferative diabetic retinopathy (PDR) in Pakistan is 2.65–5%.1,2 One of the major causes of visual impairment in patients of proliferative diabetic retinopathy is vitreous haemorrhage but due to emergence of vitrectomy system and rapid advancement in surgical techniques for posterior segment pathologies there is dramatic recovery of visual acuity after surgery. One of the major causes of visual impairment in patients of proliferative diabetic retinopathy is vitreous haemorrhage but due to emergence of vitrectomy system and rapid advancement in surgical techniques for posterior segment pathologies there is dramatic recovery of visual acuity after surgery. For PDR, pan retinal photocoagulation (PRP) is the primary treatment, but for more complicated cases, such as those with associated vitreous haemorrhageand/or tractional retinal detachment, a vitrectomy surgery is performed.[4,5] Closed surgical system for removal of vitreous with controlled intraocular pressure was provided by the technique described by Machemer. In 1975, O’Malley and Heinz developed the first 20-gauge 3-port parsplana vitrectomy but a number of complications had become apparent. Improvement in technique and instruments design quickly led to the development of 3-port vitrectomy system with light weight, reusable, pneumatic and electric cutters
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