Preoperative Rubeosis Research Articles

Visual outcomes and prognostic factors following 23G vitrectomy for vitreous hemorrhage in eyes with proliferative diabetic retinopathy.

We aimed to evaluate the factors influencing the visual gain following pars plana vitrectomy for vitreous hemorrhage in patients with proliferative diabetic retinopathy. A retrospective study was conducted on 172 eyes of 143 consecutive patients with diabetes mellitus between January 2012 and January 2018. Demographic data, ophthalmological findings, surgery details, and visual outcomes were gathered after consulting the patients' records. The main outcome measured was the improvement of best corrected visual acuity and the secondary outcomes measured were rebleeding and complications. Best corrected visual acuity improved in 103 eyes (59.88%), worsened in 45 eyes (26.16%), and remained unchanged in 24 eyes (13.95%). Type 2 diabetes mellitus was significantly associated with better final best corrected visual acuity (p=0.0244). Previous treatment by pan-retinal laser photocoagulation or intravitreal bevacizumab determined better final best corrected visual acuity, but not significantly (p>0.05). Preoperative rubeosis iridis and neovascular glaucoma did not influence the outcomes. The lack of fibrovascular proliferation requiring dissection was a significant factor for better final best corrected visual acuity (p=0.0006). Rebleeding occurred in 37.1% of the eyes and it was not influenced by the antiplatelet drugs (p>0.05). Postoperative neovascular glaucoma was a negative prognostic factor (p=0.0037). The final best corrected visual acuity was influenced positively by type 2 diabetes mellitus and the absence of preoperative extensive fibrovascular proliferation and negatively by postoperative neovascular glaucoma.

Risk Factors for Redetachment and Worse Visual Outcome after Silicone Oil Removal in Eyes with Complicated Retinal Detachment

The goal of this study was to identify risk factors for redetachment and/or a worse visual outcome after silicone oil removal (SOR) for complicated retinal detachment. The authors retrospectively analyzed 287 consecutive eyes with SOR between January 1999 and December 2003. Anatomic success after SOR was achieved in 81% of the eyes. The overall anatomic success at the end of follow-up was 94%. Postoperative ocular hypertension was found in 8% of the eyes, hypotony in 6% of the eyes, and keratopathy in 29% of the eyes. After SOR 43% of the eyes had an improvement in visual acuity of at least two Snellen lines. After multivariate analysis, male sex, the presence of preoperative rubeosis, and proliferative diabetic retinopathy (PDR) were found to be risk factors for recurrent retinal detachment. Male sex, preoperative visual acuity of <0.1 Snellen lines, PDR, the performance of three more operations, any size of retinectomy, and hypotony were found to be associated with a poor visual outcome of Snellen visual acuity <0.1. Retinal detachment after SOR in the current unselected series of eyes occurred in approximately 20%, which is comparable to the Silicone Oil Study reports, published approximately 20 years ago. However, preoperative selection was then made, and less than 50% of the silicone oil-filled eyes had SOR. The higher overall anatomic success in the current study may be due to improved vitreoretinal surgical techniques.

Re-Worsening Factor after Successful Vitrectomy for Diabetic Retinopathy: Optic Disc Fibrovascular Proliferation and Macular Disease

Purpose: To investigate the factors that influence the visual-changing pattern in proliferative diabetic retinopathy even after successful vitrectomy. Methods: One hundred and forty-seven consecutive eyes were retrospectively reviewed for 6–48 (average 20) months, and were divided into the following 4 groups based on their changing pattern of vision: group A, the visual acuity improved postoperatively and maintained the maximal corrected vision throughout the observation period (n = 49); group B, the visual acuity improved postoperatively but deteriorated thereafter (n = 68); group C, the visual acuity remained the same as before operation (n = 17), and group D, the visual acuity deteriorated immediately after vitrectomy (n = 13). Various issues including systemic conditions, blood tests, preoperative ocular findings, the operative procedures and postoperative complications were reviewed based on the patient records. These issues were analyzed by Spearman’s rank correlation, χ² test, an analysis of variance (ANOVA) and the Kruskal-Wallis test. Finally, the discriminate factors between groups A and B were examined by a stepwise logistic regression analysis. Results: The following tendencies were observed in all 4 groups: younger patients tended to show a better visual-changing pattern (p = 0.02); patients with younger age at diabetes onset had a better visual-changing pattern after vitrectomy (p = 0.001), and a lower hemoglobin (Hb) A1c level is associated with a better visual changing pattern (p = 0.017). Preoperative rubeosis and macular detachment were frequently found in groups C and D, as well as postoperative rubeosis, vitreous bleeding and retinal detachment. Finally, a stepwise logistic regression analysis showed both fibrovascular proliferation (p = 0.016) from the optic disc and postoperative macular disease (p = 0.0009) to be significant factors for differentiating group A from group B. Conclusions: In addition to the factors which have already been indicated to affect the visual outcome of a vitrectomy, preoperative findings such as optic disc fibrovascular proliferation and postoperative macular disease were found to affect the visual-changing pattern after a successful vitrectomy. The optimal timing of surgery is very important not only in order to obtain good visual acuity but also to maintain good vision even after a successful vitrectomy.

Laser Trabeculodissection With a Photopolishing Scanning Excimer Laser

A phase I study of nonpenetrating trabeculectomy (Zimmerman procedure) using a scanning excimer laser system was conducted to evaluate the ability of this laser system to achieve the deep dissection required to allow significant filtration without inadvertent penetration into the anterior chamber. A photopolishing, scanning 193 nm excimer laser system (LS 2000, LaserSight, Inc.) was used with a proprietary fluence, spot size, scanning pattern, and ablation shape to perform a trabeculodissection under a scleral flap with a limbal-based conjunctival flap in 8 cases of advanced glaucoma including 5 eyes that had a failed trabeculectomy. The laser trabeculodissection (LTD) was carried through Schlemm's canal and the juxtacanalicular trabecular meshwork, achieving vigorous aqueous outflow. No peripheral iridectomy was done. The scleral flap was closed loosely with a 10-0 suture. Mitomycin-C was used intraoperatively. In no case did inadvertent penetration into the anterior chamber occur. No peripheral iridectomy was performed. No intraoperative hyphema occurred. There was no postoperative iritis except minimal anterior chamber reaction in 1 eye with preoperative rubeosis. Postoperatively, a good filtering bleb was achieved in all 8 eyes with substantial reduction in the intraocular pressure without topical antiglaucoma therapy. No cases of postoperative shallowing (overfiltration) occurred. Gonioscopy, postoperatively, revealed no new peripheral anterior synechiae (PAS) to the filtration site and an intact inner trabecular meshwork. All eyes were followed for a minimum of 6 months. In this phase I study, laser trabeculodissection (LTD) with a 193 nm photopolishing, scanning system appears to be a promising alternative to full-thickness trabeculectomy, achieving significant filtration while perhaps avoiding much of the risk of filtration surgery. The laser system seemed to provide a more reliable, better-controlled dissection than a knife. The aqueous drainage seems to have acted as a self-regulating endpoint by absorbing UV energy, thus avoiding inadvertent penetration into the anterior chamber. More study is needed to establish the appropriate role of LTD in glaucoma therapy.

Vitrectomy for Proliferative Diabetic Retinopathy Associated With Iris Rubeosis

To compare the results of vitrectomy for phakic cases and those of aphakic cases with proliferative diabetic retinopathy (PDR) accompanied by rubeosis iridis. We reviewed 34 eyes of 24 cases that underwent vitrectomy for proliferative diabetic retinopathy with rubeosis iridis. Phakic eyes needed significantly more reoperations (p < 0.001) than aphakic eyes. Aphakic eyes had significantly more successful visual results (p < 0.05) and better control of intraocular pressure (p < 0.005) than phakic eyes. This study showed the possibility that phakic eyes had more ischemic retina producing more angiogenic factors than aphakic eyes which had the same grade of rubeosis iridis. Phakic eyes with pre-operative rubeosis iridis need thorough clearance of ocular ischemia by panretinal photocoagulation.

Transient Hypopyon Following Primary or Adjunct Argon Laser Photocoagulation-Reply

In Reply. —We appreciate the comments and additional references provided by Dr Shin. The differential diagnosis in our two cases included microbial endophthalmitis as well as an exaggerated inflammatory reaction related to panretinal laser endophotocoagulation or to contaminants in the silicone oil. Both patients developed marked anterior chamber fibrin as well as a prominent hypopyon following pars plana vitrectomy, laser endophotocoagulation, and silicone oil injection. Neither of these patients had preoperative rubeosis iridis and neither received iris photocoagulation. A common standard of care in presumed microbial endophthalmitis is to obtain intraocular cultures and administer intraocular and periocular antibiotics and steroids. In reviewing the literature on reported endophthalmitis cases following vitrectomy and silicone oil injection, a consistent observation was made of purulent material in front of or below the silicone oil, as well as severe ocular pain. Although ocular pain did occur in one of our two patients, it was not

Der Einfluß von Rubeosis iridis und aktiven Neovaskularisationen am Fundus auf die Ergebnisse der Glaskörperchirurgie bei der proliferativen diabetischen Retinopathie

To determine the influence of preoperative rubeosis iridis and active neovascularization at the fundus on surgical results, the authors analyzed a consecutive series of 85 eyes that underwent vitrectomy for diabetic tractional detachment of the macula. Minimum follow-up was 12 months. Rubeosis was present in 51%, active neovascularization at the fundus in 82%. Surgery was performed under Spitznas wide-angle observation using a stereoscopic diagonal inverter either with the panfundoscope or binocular ophthalmoscopy through the operating microscope. In the 93% of the eyes that were phakic no lensectomy was performed. Anatomical success was achieved in 79%, ambulatory vision in 74%. Anatomical success was reduced to 58% in cases with preoperative rubeosis and to 70% in cases with active neovascularization at the fundus. Including four cases of re-vitrectomy, silicone oil was used for internal tamponade in 9%, SF 6/air 50:50 in 38% and air in 28%. In 25% no internal tamponade was applied. Postoperative complications included vitreous bleeding (21%), increased rubeosis (20%), neovascular glaucoma (2%), redetachment (6%), rubeosis/hypotony/cataract (13%) and phthisis (3.5%). In 21% of the eyes the final result of surgery was failure, due to redetachment (3.5%), neovascular glaucoma (1%), rubeosis/hypotony/cataract (13%) and phthisis (3.5%).

REGRESSION OF DIABETIC RUBEOSIS IRIDIS FOLLOWING SUCCESSFUL SURGICAL REATTACHMENT OF THE RETINA BY VITRECTOMY

The relationship between successful surgical reattachment of the retina following diabetic vitrectomy and regression of preoperative rubeosis iridis was investigated. Seventy-nine (9.2%) of 850 diabetic cases undergoing vitrectomy had both preoperative iris rubeosis and retinal detachment. The iris could be adequately evaluated and the retina could be visualized after surgery in 36 cases. Regression of the rubeosis iridis occurred after surgery in 16 (76%) of 21 eyes in which the retina was reattached successfully. Only four (27%) of 15 eyes had regression of rubeosis iridis when the retina was not reattached completely. Retention of the lens also correlated with regression of rubeosis iridis. Regression occurred in 10 (55%) of 18 cases in which the lens was not removed, 13 (28.2%) of 46 eyes in which lensectomy was combined with vitrectomy, and none of eight previously aphakic eyes. Although the combination of preoperative retinal detachment and rubeosis iridis is associated with a worsened prognosis, successful reattachment of the retina and retention of the lens favorably influence later regression of preoperative rubeosis iridis.

Preoperative Iris Rubeosis and Diabetic Vitrectomy Results

Six hundred and forty-five patients undergoing pars plana vitrectomy for diabetic retinopathy without preoperative iris rubeosis were followed for six months and compared with 69 patients that had preoperative pupillary rubeosis and 30 patients that had preoperative peripheral iris and/or angle rubeosis. Preoperatively, the patients' general characteristics were quite similar, but those cases with peripheral iris rubeosis had poorer visual acuities due to a higher incidence of dense vitreous hemorrhages (70%), as compared with those without rubeosis (56%), and a higher incidence of cataracts and prior cataract surgery. The operative procedures were complicated by retinal holes in 40% of the cases with peripheral rubeosis compared with 24% of those without rubeosis. Postoperatively, elevated intraocular pressures occurred in 67% of the cases with preoperative peripheral rubeosis compared with 58% of those with preoperative pupillary rubeosis and 37% of those without preoperative rubeosis. Postoperative steroids were required more frequently in those eyes with preoperative rubeosis. Six months after vitrectomy, the visual results were much better in those eyes without preoperative rubeosis, but 27% of the cases with preoperative peripheral rubeosis had obtained 6/60 visual acuity or better. As expected, there was a direct correlation between the extent of iris rubeosis at the preoperative examination and at the six-month postoperative examination. Regression of preoperative rubeosis definitely occurred in some eyes during the postoperative period. Phthisis had occurred or was occurring in 23% of the eyes with preoperative peripheral rubeosis compared with 15% of the eyes without preoperative rubeosis or with rubeosis confined to the pupil. Determination of the exact incidence of neovascular glaucoma during the six-month follow-up period was difficult, but was probably 33% for those cases with preoperative peripheral rubeosis, as compared with 17% for those without preoperative rubeosis.Opacities of the anterior segments prevented evaluation of more posterior structures in many cases, especially those with preoperative peripheral rubeosis of which 47% had obscured vitreous cavities, as compared with 20% of those without preoperative rubeosis. Of those that could be visualized, the vitreous cavities were usually clear and the retinas attached.