Diabetic Tractional Retinal Detachment Research Articles

The effect of adjuvant Mitomycin C during vitrectomy on functional and anatomical outcomes in patients with severe diabetic tractional retinal detachment.

To evaluate the effect of adjuvant Mitomycin C (MMC) use on the anatomical and functional success of vitreoretinal surgery (VRS) in severe diabetic tractional retinal detachment (dTRD) patients. A retrospective analysis of consecutive patients undergoing VRS due to severe dTRD was conducted. Patients were categorized into those who received 20µg/0.1mL MMC via MMC sandwich method (Group 1) and those who did not (Group 2). Demographics, surgical characteristics, visual outcomes, and complications that may related to MMC were analyzed. A total of 25 eyes were included, 13 in Group 1 and 12 in Group 2. No statistical difference was observed in baseline characteristics between the groups. The mean best-corrected visual acuity was 1.90 ± 0.43 logMAR and 1.93 ± 0.41 logMAR preoperatively and 1.60 ± 0.78 logMAR and 1.56 ± 0.78 logMAR postoperatively in Groups 1 and 2, respectively (p = 0.154). The postoperative mean intraocular pressure was 16.23 ± 2.55mmHg and 13.08 ± 4.94mmHg in Groups 1 and 2, respectively (p = 0.225). The rate of re-surgery was significantly lower in Group 1 (0% vs. 41.7% in Group 2, p = 0.015). Retina was attached in all patients at the last visit. No MMC-related complication was recorded. Intraoperative adjuvant MMC application for severe dTRD significantly reduces re-surgery rates with good anatomical and functional outcomes safely.

Spontaneous resolution of a diabetic traction retinal detachment

Spontaneous resolution of a diabetic traction retinal detachment

Incidence of Postoperative Epiretinal Membrane Development Following 23-Gauge Pars Plana Vitrectomy for Complex Diabetic Tractional Retinal Detachment: A Comparative Study of Silicone Oil and Balanced Salt Solution Tamponade

BACKGROUND: Tractional retinal detachment (TRD) poses a significant threat to vision in diabetic patients, necessitating surgical intervention. However, the choice of tamponade agent (silicone oil vs. balanced salt solution [BSS]) and the presence of incomplete hemostasis during surgery can influence postoperative complications, specifically the development of epiretinal membranes (ERMs). METHODS: This prospective study involved 235 patients undergoing 23-Gauge pars plana vitrectomy for diabetic TRD with incomplete hemostasis. Patients were categorized into two groups based on tamponade agent used. ERM development was assessed clinically and through optical coherence tomography (OCT). RESULTS: Among the cases with incomplete hemostasis and residual preretinal hemorrhage, 71.80% of those in the silicone oil group developed ERMs, in contrast to 11.76% in the BSS. Notably, 46.2% of silicone oil cases with ERMs required reoperation, whereas 47.4% remained ERM-free. DISCUSSION: The choice of tamponade agent was a crucial determinant in ERM development, with silicone oil exhibiting a significantly higher incidence. Moreover, silicone oil cases with macular tractional effects had a substantial proportion of ERMs necessitating reoperation. These findings underscore the importance of vigilant postoperative monitoring. CONCLUSION: In cases involving incomplete hemostasis during vitrectomy for diabetic TRD, the use of silicone oil as a tamponade agent is associated with a substantially increased risk of postoperative ERM development. Clinically, this highlights the need for meticulous patient management. Further research is warranted to validate these results and explore long-term outcomes.

Effects of internal limiting membrane peeling versus non-internal limiting membrane peeling during vitrectomy for diabetic tractional retinal detachment on postoperative macular thickness, foveal contour, and formation of epiretinal membranes

Aim To investigate the impact of internal limiting membrane (ILM) peeling during vitrectomy for diabetic tractional retinal detachment (TRD) on postoperative central macular thickness, foveal contour, and creation or reformation of epiretinal membranes. Methods In a randomized trial, patients aged 40–65 years old with TRD were recruited from the outpatient clinic in Suez Canal University Hospital from August 2020 to February 2022. Patients were randomized into two groups: group 1 did vitrectomy with ILM peeling, while group 2 did vitrectomy without ILM peeling. At 1, 3, and 6 months after surgery, optical coherence tomography (OCT) was carried out to investigate the central macular thickness (CMT), foveal contour, and epiretinal membrane’s presence. For categorical variables, the Chi-squared test or Fisher’s exact test was performed, while the Student’s t-test was used to assess differences in continuous data. Results Thirty-two patients (16 in each group) completed the required follow-up. There was no significant difference between both groups concerning the affected eye (P=1.00). There was no statistically significant difference regarding the CMT recorded via optical coherence tomography at any point of follow-up in the two groups (P=0.289). Also, there was no statistically significant difference regarding the presence of foveal depression at any point of follow-up in the two groups (P=0.680). On the other hand, the percentage of patients who showed no presence of epiretinal membranes in the ILM peeling group was statistically significant when compared with the non-ILM peeling group (P<0.001). Conclusions ILM peeling decreases the incidence of epiretinal membrane proliferation following diabetic vitrectomy.

Long-Standing Macula-Involving Diabetic Tractional Retinal Detachments with Good Visual Acuity: How Should We Manage These Patients?

We assess the merits of pars plana vitrectomy (PPV) in subjects with good visual acuity (VA) and a chronic macula-involving tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR). A retrospective review of medical records was undertaken. Subjects were divided into 1) a Study Group of subjects who underwent prompt PPV and 2) a Control Group of subjects in which PPV was deferred in favor of less invasive treatment options or observations. Both study and control subjects had a baseline Snellen VA of ≥20/50 and a PDR-associated macula-involving TRD of >6 months duration with a minimum follow-up of 12-months. There were 58 patients analyzed over an average follow-up period of 27.6 (±7.1) months. The change in VA was similar in the Study Group compared to the Control Group (p=0.94) with both groups losing about three lines of VA during the study period (-0.30 ±0.52 logMAR). Although the rates of maintaining ≥20/200 Snellen VA and ≥20/50 Snellen VA were similar in the Study Group compared to the Control Group (p=0.55 and p=0.28, respectively), the Study Group had more subjects gaining ≥2 lines of VA during the study period (p=0.002). Patients presenting with good VA and a PDR-associated macula-involving TRD of >6 months were more likely to gain ≥2 lines of VA when PPV was performed at baseline compared to PPV deferral until further deterioration occurred.

Minimal, Relaxing Membranectomies for the Management of Opacified Hyaloid With Diabetic Tractional Retinal Detachments in Monocular Patients: A Novel Surgical Technique.

Vitrectomy for severe tractional retinal detachments is a high-risk procedure given the surgical complexity and potential for postoperative complications. The risk is compounded when operating on monocular patients. We developed a novel technique using hyaloidal removal and minimal relaxing membranectomies for tractional retinal detachments with an opacified hyaloid over the fovea in monocular, diabetic patients and evaluated complications and outcomes. The technique was performed in nine monocular, diabetic patients with decreased visual acuity from opaque hyaloid with centripetal tractional retinal detachments. Outcomes included postoperative best-corrected visual acuity, retinal reattachment rate, redetachments, and complications. Average age was 58 years (range 43-74) and the average follow-up time was 43.6 months (range 36-64). Preoperative best-corrected visual acuity ranged from 1.0 to 2.3 logMAR (20/200 - Hand Motion) with a mean of 1.39 logMAR (20/500). Postoperative best-corrected visual acuity at last follow-up ranged from 0.2 to 1.0 logMAR (20/30-20/200) with a mean of 0.49 logMAR (20/60) ( P < 0.001). All eyes had attached posterior poles at last follow-up. Complications were observed in two eyes and included nonclearing hemorrhage and capsular opacity. Vitrectomy with minimal, relaxing membranectomies is an option for monocular patients in whom intervention is needed, but are at high risk for complications.

Intraocular Fibrin Glue to Lower the Risk of Postoperative Vitreous Hemorrhage After Diabetic Pars Plana Vitrectomy.

To investigate the use of intraocular fibrin glue to lower the risk of vitreous hemorrhage (VH) after pars plana vitrectomy (PPV) in eyes with diabetic VH or traction retinal detachment. A matched, case-control, single-surgeon, pilot study of patients undergoing PPV for diabetic VH or traction retinal detachment with versus without fibrin glue was performed. Thirty-nine patients (13 glue and 26 control patients) were included. In the glue group, mean (SD) logarithm of the minimum angle of resolution visual acuity (Snellen) significantly improved from 1.53 (0.6) (20/678) to 0.99 (0.9) (20/195) at postoperative month 6 ( P = 0.03). In the control group, mean logarithm of the minimum angle of resolution visual acuity also improved from 1.45 (0.8) (20/564) to 1.17 (0.9) (20/296) at postoperative Month 6 ( P = 0.3). Persistent post-PPV VH was similar between the 2 groups (15.4% in both groups, P > 0.99). However, early recurrent VH (<3 months post-PPV) was seen in 34.6% in the control group and none in the glue group ( P = 0.02). No intraocular inflammatory events were seen in the glue group. Intraocular fibrin glue may be a safe adjuvant in diabetic vitrectomy and may reduce the rate of early recurrent postoperative VH.

Surgical Treatment Approaches and Membrane Peeling Techniques in Diabetic Tractional Detachment

Vitreoretinal surgeons usually classify diabetic tractional retinal detachments as macular/non-macular involvement. However, the conditions requiring surgical treatment in advanced diabetic patients have changed due to the technical and instrumentation developments that have occurred in the last 20 years, especially in vitreoretinal surgery. Non-regressive intravitreal hemorrhages, which are classic indications, have gone far beyond the indications of traction retinal detachment that holds the macula, and are moving to a stage where early vitrectomy will soon replace them.

The Anatomical and Functional Outcomes of 27-Gauge Pars Plana Vitrectomy in Diabetic Tractional Retinal Detachments in the South Asian Population.

Objective The objective of this article was to report the clinical and surgical outcomes of diabetic tractional retinal detachment (TRD) with 27-gauge plus pars plana vitrectomy (27G+ PPV) Methods This is a retrospective, consecutive cohort study of196 eyes of 176 patients that underwent 27G+ PPV for TRD from July 2015 to June 2019 at the ophthalmology department of Shifa International Hospital, Islamabad. The outcomes includeprimary and secondary anatomical attachment of the retina, best-corrected visual acuity, and post-operative complications. Results The mean age of the patients in this study was 55.3 ± 11.3 years. Out of 176 patients, there were 47.2% (n=83) females. The mean operating time calculated was 60 ± 36 min (range 22-130 min). Of 196 eyes, 64.3% (n=126) also combined phacoemulsification with lens implantation. Internal limiting membrane peeling was done in 11.7% (n=23) of the cases. Post-operatively, 98% (n=192) achieved primary retinal attachment, and 1.5% (n=3) underwent a second procedure to achieve retinal attachment. At three months follow-up, the mean best corrected visual acuity (BCVA) remarkably improved from 1.86 ± 0.59 to 0.54 ± 0.32 logarithm of the minimal angle of resolution (logMAR) (p-value<0.001). Among complications, one patient had intra-operative suprachoroidal oil migration, which was managed successfully, while post-operatively, 11 patients (5.6%) developed a transient rise in intraocular pressure, which was controlled with anti-glaucoma drugs, and one patient had vitreous cavity hemorrhage which resolved on its own with time. Conclusion This study strongly suggests that the 27G+ PPV offers successful repair of eyes with diabetic TRD with statistically significant improvement in visual acuity and minimal rate of complications.

Clinical Outcomes of 27-Gauge Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment Repair.

Purpose: To analyze the clinical outcomes of 27-gauge pars plana vitrectomy (PPV) repair of diabetic tractional retinal detachment (TRD) of various severities. Methods: This retrospective case series examined the outcomes of 27-gauge PPV to repair diabetic TRD from 2016 to 2020. The effect of medical and ophthalmologic history parameters and baseline detachment characteristics on visual acuity (VA) and retinal reattachment was analyzed. A grading system was established to stage the severity of the baseline vitreoretinal traction or detachment and compare the visual and anatomic outcomes between stages. Results: The study comprised 79 eyes (79 patients). The overall redetachment rate was 10.1% (8/79). The proportion of eyes with severe visual impairment (worse than 20/200) decreased from 81.0% (64/79) preoperatively to 56.9% (37/65) 6 months postoperatively (P < .001). Worse preoperative logMAR VA was associated with greater odds of redetachment (P = .017) and worse postoperative VA (P < .001). Insulin dependence was associated with better VA at 6 months (P = .017). A shorter known duration of diabetes (P = .026) and evidence of neovascularization of the iris (NVI) or angle (P = .004) were associated with worse visual outcomes. Eyes with detachment involving the posterior pole extending beyond the equator had worse VA at 6 months (P = .048). Conclusions: The primary reattachment rate after 27-gauge PPV was 89.9%. There was significant VA improvement, with a roughly 40% reduction in the number of eyes with severe visual impairment by the final follow-up. Insulin dependence, duration of diabetes, presence of NVI before surgery, and baseline posterior pole detachment extending beyond the equator were predictors of visual outcomes.

Diabetic retinal detachment surgery at a central academic hospital, Johannesburg, South Africa

Background: Tractional retinal detachment surgery outcomes are unpredictable and need to be reviewed regularly in clinical practice settings.Aim: To describe the visual acuity and anatomical outcomes of retinal detachment surgery for diabetic tractional retinal detachment at a central academic hospital.Setting: Johannesburg, South Africa.Methods: This study involves a retrospective case series of patients who had surgery for diabetic tractional retinal detachment at Charlotte Maxeke Johannesburg Academic Hospital between 01 January 2010 and 31 December 2014.Results: A total of 65 patients with diabetic retinal detachment were included in this study. The study consisted of 63% (n = 41) male patients and 37% (n = 24) female patients. The mean age (± standard deviation) was 54 ± 12.2 years. Forty-four patients (68%) had tractional retinal detachment, and 21 (32%) patients had a combined tractional and rhegmatogenous retinal detachment. Twenty-one (32%) patients had detachments associated with vitreous haemorrhage (VH), and 39 (60%) patients had macular-involving detachments. Forty-six (71%) patients obtained vision improvement or stabilisation and reattachment of the retina, 24 (36.9%) patients had visual acuity improvement, 22 (33.9%) patients retained the same visual acuity and 19 (29.2%) patients lost vision. Fifty-five (85%) patients had successful anatomical reattachment of the retina, and 10 (15%) patients had re-detachments after surgery.Conclusion: The majority of patients whose files were reviewed benefited from surgical intervention for diabetic tractional retinal detachment in terms of stabilisation or improvement of vision.Contribution: Tractional detachment surgery outcomes in our setting are comparable to those from elsewhere around the world.

What Defines Successful Surgery for Diabetic Tractional Retinal Detachment?

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Effect of ILM Peeling on Anatomical and Visual Outcomes in Diabetic Tractional Retinal Detachment.

The objcetive is to compare the anatomic and functional outcomes of vitrectomy between internal limiting membrane (ILM) peeling and non-ILM peeling in diabetic tractional retinal detachment (TRD). Twenty-three eyes with diabetic TRD with ILM peeling were compared with twenty-four eyes with non-ILM peeling. Best-corrected visual acuity (BCVA) was recorded at baseline and 3, 6, 9, 12 months, and end of follow-up. The mean retinal thickness across nine different regions that defined in the Early Treatment Diabetic Retinopathy Study (ETDRS) were obtained. The ETDRS grid was used to determine the extent of macular involvement. In the 1st month postoperatively, the mean BCVA of eyes with ILM peeling (1.08±0.63 LogMAR) was significantly better than eyes with ILM non-peeling (1.69±0.75 LogMAR, p=0.003). There was also a significant difference at 9 and 12 months between groups in BCVA, in favor of ILM peeling (p=0.012 and p=0.047, respectively). Seven patients (29.2%) developed epiretinal membrane (ERM), and one patient (4.1%) had ERM with the lamellar macular hole in the ILM non-peeling group, while only one patient developed ERM in ILM peeling group during the follow-up. ILM removal may be considered in diabetic TRD surgery, as it can provide rapid visual recovery. Moreover, post-operative ERM formation was less frequent in ILM peeled eyes within 1 year after surgery.

Perioperative systemic blood pressure parameters and clinical outcomes following 27g vitrectomy for diabetic tractional detachment repair

BackgroundExtremes in perioperative blood pressures are known risk factors for adverse outcomes after surgical interventions. There is scarce literature studying these parameters as predictors of outcomes after ocular surgery.MethodsThis was...

Serum creatinine as a predictor of functional and anatomical success in diabetic tractional retinal detachment

Objectives: The aim of the study was to evaluate pre-operative, intraoperative, and post-operative factors associated with functional and anatomical success in patients with diabetic tractional retinal detachment (TRD) treated with pars plana vitrectomy (PPV). Material and Methods: We retrospectively reviewed the medical records of patients with diabetic TRD surgically repaired with PPV between March 2014 and February 2015 at the Instituto de Oftalmología Fundación de Asistencia Privada Conde de Valenciana, IAP in Mexico City. A total of 250 records were reviewed and 85 met the inclusion criteria. Pre-operative, intraoperative, and post-operative variables were obtained from all records. Statistical analysis included Fisher’s exact test, Kruskal–Wallis test, and Mann–Whitney U test. Results: A total of 88 eyes of 85 patients were included in the study. The average patient age at the time of the surgery was 51.53 years (SD ± 11.99). At post-operative month (POM) 1, a greater pre-operative serum creatinine value and a greater surgical duration were associated with a worse anatomical success (P = 0.032; P = 0.014). At POM 1, 31% of the eyes with macula-involved TRD and 57.5% of the eyes without macula-involved TRD achieved visual success (P = 0.013, Fisher’s exact test). Conclusion: A greater pre-operative serum creatinine value was associated with a worse visual and anatomical outcome at POM 1. A macula-involved TRD was associated with a worse visual outcome at POM 3. Post-operative complications were associated with a worse functional and/or anatomical success at the final follow-up visit (P &lt; 0.05).

Comparative Study between Chandlier Assisted 23, 25 and 27 Gauge Bimanual Vitrectomy for Diabetic Tractional Retinal Detachment and Vitreous Hemorrhage

Comparative Study between Chandlier Assisted 23, 25 and 27 Gauge Bimanual Vitrectomy for Diabetic Tractional Retinal Detachment and Vitreous Hemorrhage

An update on the management of diabetic tractional retinal detachment

Background: Tractional retinal detachment (TRD) occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. The pre-operative use of antivascular endothelial growth factor (anti-VEGF) and advances in microsurgical instrumentation, such as a small gauge vitrectomy (SGV), have improved surgical outcomes.Aim: The purpose of this review is to highlight recent trends in the management of diabetic TRD, supporting earlier surgical intervention and the expanded surgical indications.Methods: PubMed was searched for the following terms: ‘diabetes’ OR ‘diabetic retinopathy’ AND ‘TRD’ AND ‘pars plana vitrectomy (PPV)’ AND ‘anti-VEGF’ AND ‘endophotocoagulation’. Reference lists were reviewed for additional articles. The review was focused on all articles later than 2010 for recent updates on the ever-changing management of this disease entity. No case reports were included in this review article.Results: Management of TRD continues to remain challenging, despite the recent advancements in techniques and instrumentation. Each case needs to be individualised, with careful pre-operative planning, understanding of patient expectations and counselling, coupled with meticulous surgical skills and diligent postoperative management.Conclusion: Management of TRD continues to remain challenging despite recent advances in techniques and instrumentation. Vitrectomy for TRD can improve vision-related quality of life, and the continued evolution and improvement in surgical techniques and adjunctive pharmacotherapy will most likely continue to improve postoperative outcomes.Contribution: The paper presents an overview of current management of tractional retinal detachment in patients with advanced proliferative diabetic retinopathy.

Favorable Anti-VEGF Crunch Syndrome: Nonsurgical Relief of Vitreoretinal Traction in Eyes With Proliferative Diabetic Retinopathy and Tractional Retinal Detachment

Herein are reported four eyes among three patients with favorable anti-vascular endothelial growth factor crunch syndrome by which contraction of fibrovascular tissue led to relief of vitreoretinal traction without surgical intervention. This phenomenon led to complete or partial retinal reattachment in two patients with diabetic tractional retinal detachments. These cases represent favorable anatomic outcomes of crunch syndrome secondary to anti-vascular endothelial growth factor pharmacotherapy and are unique compared with most cases, which have been associated with negative outcomes. [Ophthalmic Surg Lasers Imaging Retina 2022;53:455-459.].

Intravitreal recombinant tPA before vitrectomy for diabetic tractional retinal detachment: A randomized controlled trial.

To investigate the effect of intravitreal recombinant tissue plasminogen activator (rt-PA) injection before vitrectomy on surgical facility and outcome in diabetic tractional retinal detachments (TRD). Prospective, randomized, interventional clinical trial. A total of 38 eyes with diabetic TRD were candidates for vitrectomy. Patients were randomized 1:1 to receive intravitreal rt-PA, five to seven days before vitrectomy or no injection. Intraoperative surgical facility and anatomic success at month 3 after surgery were assessed. Mean patient age was 54.2 ± 9.4 years. There was no statistically significant difference between rt-PA and no injection groups with regard to anatomic success (89% versus 95%, respectively, P = 0.547) and best corrected visual acuity at 3 months (2.0 versus 2.1 logMAR, respectively, P = 0.840). However, surgical facility score was statistically significantly lower in rt-PA injection group compared to no injection group (4.1 ± 1.7, 5.8 ± 2.0, respectively, P = 0.007). Vitrectomy for TRD was easier after preoperative rt-PA injection, without affecting the anatomic and visual outcomes.

Efficacy and Safety of Micropulse Transscleral Laser Therapy in Silicone Oil-induced Glaucoma.

The purpose of this study was to assess the efficiency and safety of micropulse transscleral laser therapy (MP-TLT) in the management of silicone oil-induced glaucoma (SOG). A prospective case series of 33 eyes with uncontrolled SOG was enrolled at the Department of Ophthalmology of Mohamed Taher Maamouri Hospital, Nabeul, Tunisia. Patients were treated with MP-TLT using the IRIDEX Cyclo G6 Glaucoma Laser System with the MicroPulse P3 fiberoptic handheld probe. Patients underwent complete ophthalmologic examination during the 12-month follow-up period. The study included 33 eyes of 33 patients. The mean age was 50.39 years old. We included patients with SOG. Silicone oil tamponade was indicated for complicated rhegmatogenous retinal detachment in 22 cases, diabetic tractional retinal detachment in 10 cases, and posttraumatic retinal detachment in 1 case. Silicone oil was already removed before the procedure in 23 eyes. Silicone oil tamponade duration varied between 3 and 26 months. Intraocular pressure (IOP) measurements at enrollment; days 1, 7, and 15; and months 1, 3, 6, and 12 was respectively 37.94±13.61, 19.03±10.98, 16.5±6.17, 19.45±9.73, 19.27±8.33, 19.39±9.52, 19.97±10.03, and 19.7±9.58 mm Hg. The percentage of IOP lowering was 45.38% at 6 months and 45% at 12 months. The success rate was 93.93% at 6 months, remaining stable at 12 months. No major side effects were observed, in particular, no phthisis bulbi nor prolonged inflammation. There was no difference in IOP lowering between patients with silicone oil or those after silicone oil removal ( P =0.99). MP-TLT was safe and effectively lowered IOP in uncontrolled SOG.