Surgery For Proliferative Diabetic Retinopathy Research Articles

Fibrin Glue-Assisted Hemostasis during Proliferative Diabetic Retinopathy Surgery

Fibrin Glue-Assisted Hemostasis during Proliferative Diabetic Retinopathy Surgery

Enhancing surgical precision and efficiency: a study and comparison of a three-dimensional surgical video system in proliferative diabetic retinopathy surgery.

This study aimed to investigate the safety and efficacy of three-dimensional (3D) surgical video systems for proliferative diabetic retinopathy (PDR). This retrospective clinical case study included 30 patients (30 eyes) with PDR. Patients were divided into two groups: one underwent surgery using a 3D surgical video system (14 cases, 14 eyes), while the other underwent traditional microscope surgery (16 cases, 16 eyes). Safety and efficacy were assessed through predetermined surgical parameters, including surgical duration, intraoperative membrane removal rate, and occurrences during intraoperative and postoperative phases. Our study revealed noteworthy differences in various aspects between the 3D surgical video system group and the traditional microscope surgery group. Specifically, the mean surgical time was 30.25 ± 14.43 mins in the 3D surgical video system group, while it was 38.56 ± 18.71 mins in the traditional microscope surgery group (p = 0.051). Furthermore, the mean membrane removal time was significantly shorter in the 3D group at 2.53 ± 1.52 mins, as compared to 3.23 ± 1.76 mins in the traditional group (p = 0.042). Importantly, the membrane removal rate also displayed a significant difference, with the 3D group at 0.55 ± 0.07 and the traditional group at 0.41 ± 0.11 (p = 0.018). However, no notable differences were observed between the two groups in terms of intraoperative and postoperative incidences. The safety and efficacy obtained using the 3D surgical video system in PDR surgery were comparable to those obtained in traditional microscopic surgery.

Отдаленные результаты применения вискодиссекции с контрастированием в хирургии пролиферативной диабетической ретинопатии

Purpose. To evaluate long-term results of surgery for proliferative diabetic retinopathy using contrast-enhanced viscodissection. Material and methods.The study involved 30 patients with type 1 diabetes mellitus (DM) and PDR with traction retinal detachment (TRD). All patients were divided into two groups. In the main group, viscodissection with contrast was performed; in the control group, segmentation and membrane removal were performed using a vitreotome and endovitreal forceps. The observation period was 12 months. Results. During dynamic observation, all patients showed a positive dynamics of morphofunctional parameters. In patients of the control group, in the vast majority of cases, it was necessary to resort to tamponade with silicone oil (60%) or gasair mixture (33%), while in the main group, the main postoperative media were sterile BSS solution (73%) and gas-air mixture (27%). 60% of patients in the control group required a reoperation to remove silicone oil. In patients of the control group in the late postoperative period, IOP values were significantly higher (main group 14.3 ± 1.1; control group 18.7 ± 1.5; p < 0.05), and late postoperative vitreous hemorrhage developed more often (2.3 ± 0.5 in the main group, 4.1 ± 0.6 in the control group; p < 0.05). Conclusion. In the long-term follow-up, the use of this method reduces the need for repeated endovitreal intervention, reduces the risk of developing late postoperative vitreous hemorrhage, and has a positive effect on IOP by reducing the need for endotamponade with silicone oil. Keywords: diabetes mellitus, proliferative diabetic retinopathy, vitreoretinal surgery, contrastenhanced viscodissection

Virtual Clinics for Diabetes Care.

Virtual Clinics for Diabetes Care.

Correlation between the Outcome of Vitrectomy for Proliferative Diabetic Retinopathy and Erythrocyte Hematocrit Level and Platelet Function.

We investigate-d whether biomarkers such as red blood cell hematocrit (Hct), platelet count (PLT), mean platelet volume (MPV), and platelet distribution width (PDW) are useful prognostic indicators of postoperative macular edema (ME) after vitrectomy for proliferative diabetic retinopathy (PDR). A total of 42 eyes of 42 patients with PDR who underwent vitrectomy between January 2018 and May 2020 were analyzed retrospectively. We divided them into two groups according to whether treatment was required for postoperative ME and compared the relationship between Hct, PLT, MPV, and PDW and the onset of postoperative ME. The group that received postoperative treatment (group T) comprised 11 eyes of 11 patients, and the group that did not (group N) comprised 31 eyes of 31 patients. The age (years) was 52.0 ± 3.1 in group T and 60.0 ± 11.6 in group N. When appropriate statistical analysis was performed for comparison between groups, significant differences were found in age (p = 0.05), insulin use (p = 0.03), preoperative intraocular pressure (p = 0.05), diastolic blood pressure (p = 0.03), and Hct (p = 0.04). Multivariate logistic regression analysis was performed, and a significant difference was found in Hct (p = 0.02). These results suggest that Hct might be useful as a predictor of ME after PDR surgery.

Оценка технических особенностей выполнения витреоретинальной хирургии при пролиферативной диабетической ретинопатии у пациентов молодого возраста

Aim. To investigate the technical difficulties of performing the stages of vitreoretinal surgery, the peculiarities of the surgical technique in young patients with the proliferative stage of diabetic retinopathy (DR). Methods. Twelve patients (12 eyes) with type 1 diabetes mellitus (DM) were selected. Their average age was 26±2 years (from 19 to 30 years). There were 4 men and 8 women. All patients had DM since childhood. Selection criteria: presence of indications for vitreoretinal surgery for proliferative DR, age of patients with type 1 DM not more than 30 years, onset of DM in childhood. Results. Initially, the clinical manifestations of proliferative DR in young people with type 1 DM were distinguished by the severity of neovascular and fibrous growths, a tendency to hemorrhages, and the complexity of preoperative preparation in the form of panretinal laser coagulation, at least partial. Surgical removal of vitreoretinal adhesions and elimination of neovascularization zones differed in technical difficulties associated with their higher density and the area of retinal tissue lesion. Conclusion. Surgical treatment of proliferative DR in young patients has a number of technical difficulties associated with the density and length of fibrovascular vitreoretinal growths, the difficulty of separating them due to the high tendency of newly formed vessels to hemorrhages. Key words: proliferative diabetic retinopathy; endovitreal surgery; type 1 diabetes mellitus; young age.

Factors correlated with visual outcomes at two and four years after vitreous surgery for proliferative diabetic retinopathy.

Proliferative diabetic retinopathy (PDR) is the most severe case of diabetic retinopathy that can cause visual impairment. This study aimed to reveal the factors correlated with better postoperative visual acuity after a long follow-up in patients who underwent vitrectomy for PDR. We retrospectively analyzed the data set including systemic findings, ocular findings, and surgical factors from registered patients who could be completely followed up for 2 or 4 years after vitrectomy. We ultimately enrolled 128 eyes from 100 patients who underwent vitrectomy for PDR between January 2008 and September 2012 and were followed up for >2 years. Among them, 91 eyes from 70 patients could be followed up for 4 years. Factors related to the postoperative visual acuity of ≥20/40 and ≥20/30 after 2 and 4 years were investigated by logistic regression analysis. Better postoperative visual acuity correlated with the following factors: no rubeosis iridis ([≥20/40 at 2 years; odds ratio {OR}, 0.068; 95% confidence interval {CI}, 0.012-0.39; P = 0.003], [≥20/30 at 2 years; OR, 0.07; 95% CI, 0.01-0.40; P = 0.03], [≥20/30 at 4 years; OR, 0.078; 95% CI, 0.006-0.96; P = 0.04]), no fibrovascular membrane [(≥20/40 at 2 years; OR, 0.22; 95% CI, 0.061-0.81; P = 0.02), (≥20/40 at 4 years; OR, 0.26; 95% CI, 0.07-0.94; P = 0.04), (≥20/30 at 4 years; OR, 0.14; 95% CI, 0.04-0.52; P = 0.004)], existing vitreous hemorrhage (≥20/30 at 2 years; OR, 9.55; 95% CI, 1.03-95.27; P = 0.04), and no reoperation ([≥20/40 at 4 years; OR, 0.15; 95% CI, 0.03-0.78; P = 0.02], [≥20/30 at 4 years; OR, 0.06; 95% CI, 0.07-0.54; P = 0.01]). Treatment provision before disease severity and treatment without complications were associated with good postoperative visual acuity.

Критерии успеха хирургии пролиферативной диабетической ретинопатии

Критерии успеха хирургии пролиферативной диабетической ретинопатии

Application of heads-up 3D vision system in surgery for proliferative diabetic retinopathy with traction retinal detachment

Application of heads-up 3D vision system in surgery for proliferative diabetic retinopathy with traction retinal detachment

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review.

Background: Optical coherence tomography (OCT) has recently been introduced in the operating theatre. The aim of this review is to present the actual role of microscope-integrated optical coherence tomography (MI-OCT) in ophthalmology. Method: A total of 314 studies were identified, following a literature search adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. After full-text evaluation, 81 studies discussing MI-OCT applications in ophthalmology were included. Results: At present, three microscope-integrated optical coherence tomography systems are commercially available. MI-OCT can help anterior and posterior segment surgeons in the decision-making process, providing direct visualization of anatomic planes before and after surgical manoeuvres, assisting in complex cases, and detecting or confirming intraoperative complications. Applications range from corneal transplant to macular surgery, including cataract surgery, glaucoma surgery, paediatric examination, proliferative diabetic retinopathy surgery, and retinal detachment surgery. Conclusion: The use of MI-OCT in ophthalmic surgery is becoming increasingly prevalent and has been applied in almost all procedures. However, there are still limitations to be overcome and the technology involved remains difficult to access and use.

Surgical outcomes of vitrectomy surgery for proliferative diabetic retinopathy in patients with abnormal renal function.

To analyse the influence of renal function on the outcomes of vitrectomy for tractional-related complications in cases of severe proliferative diabetic retinopathy (PDR). Retrospective consecutive case series of 109 eyes that underwent vitreoretinal interventions for traction-related complications of severe PDR from 2014 to 2017. Data collected included patient demographics, best-corrected visual acuity (BCVA), surgical complications, and systemic markers including HbA1c and estimated glomerular filtration rate (eGFR). Renal function categories were defined as low (eGFR < 30mL/min/1.73m2), medium (eGFR 30-60mL/min/1.73m2), and normal (eGFR > 60mL/min/1.73m2). A total of 109 eyes (56% (n = 61) female) were included in the study. Overall, mean baseline BCVA improved from 1.33 logMAR to 0.91 logMAR (p < 0.001) postoperatively. Patients with low eGFR had significantly worse baseline BCVA (p = 0.039) and demonstrated greater improvement in mean BCVA (p = 0.059). Multivariate regression analysis indicated that seven predictors explained 65.5% of the variance (R2 = 0.655, F(11,97) = 16.7, p < 0.01). Reduced renal function does not adversely affect visual outcomes of vitrectomy for traction-related complications of PDR.

Association between disorganization of retinal inner layers and visual acuity after proliferative diabetic retinopathy surgery

We report to evaluate if disorganization of the retinal inner layers (DRIL) obtained by swept-source optical coherence tomography (SS-OCT) predicts the postoperative best-corrected visual acuity (BCVA) to treat proliferative diabetic retinopathy (PDR). Twenty-one eyes of 21 patients who underwent vitrectomy for PDR were studied retrospectively. BCVA and SS-OCT images were obtained until 6 months postoperatively. The associations between BCVA and SS-OCT parameters measured in a 1-mm central foveal area were evaluated. The DRIL length, external limiting membrane disruption, and ellipsoid zone (EZ) disruption 1 month postoperatively were associated positively with the postoperative logarithm of the minimum angle of resolution (logMAR) BCVA at 1, 3, and 6 months (1 month, p = 0.009, p = 0.013, p = 0.001; 3 months, p = 0.03, p = 0.021, p = 0.002; and 6 months, p = 0.021, p = 0.013, and p = 0.005, respectively). The eyes with a 500-µm or longer DRIL 1 month postoperatively (19%, 4/21 eyes) had significantly worse VA at 1, 3, and 6 months postoperatively (p = 0.007, p = 0.008, and p = 0.020, respectively). Multilinear regression analysis of all visits until 6 months postoperatively showed that the DRIL was correlated more significantly (p = 0.0004) with logMAR BCVA than the disrupted EZ length. The DRIL in the early postoperative period may predict the visual outcomes after treating PDR.

3D surgery for proliferative diabetic retinopathy

3D surgery for proliferative diabetic retinopathy

Surgical outcomes of 27-gauge and 25-gauge vitrectomy day surgery for proliferative diabetic retinopathy

To compare postoperative outcomes of 27-gauge (G) and 25-G vitrectomy conducted as day surgery for proliferative diabetic retinopathy (PDR). One hundred eighty-five consecutive PDR patients (185 eyes) who underwent primary vitrectomy (27-G in 64 eyes, 25-G in 121 eyes) were analyzed. The 27-G and 25-G groups did not differ significantly in preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score, age, or preoperative intraocular pressure. The proportions of simultaneous cataract surgery (27-G vs. 25-G: 59.4% vs. 62.4%) and air-filled eyes (76.6% vs. 85.1%) were not significantly different between two groups. Both groups showed significant improvement in ETDRS score at postoperative 1, 3, and 6months (all, P < 0.0001). Mean gain in ETDRS score from baseline was apparently better in 27-G group than in 25-G group at 1, 3, and 6months, but there were no significant differences (1month: 20.3 vs. 13.1 letters, P = 0.0703; 3months: 22.9 vs. 17.5 letters, P = 0.1561; 6months: 24.3 vs. 19.3 letters, P = 0.3313). Operation time was apparently longer for 27-G vitrectomy, but there was no significant difference (54.0 vs. 51.1min, P = 0.3676). The same was observed for postoperative intraocular pressure at postoperative day 1 (19.7 vs. 18.1mmHg, P = 0.1353). Incidence of postoperative retinal detachment (1.6% vs. 0.8%) and reoperation due to vitreous hemorrhage (6.3% vs. 6.6%) was not different between two groups. The 27G system is as safe and as usefulas the 25G system when used for PDR and can be expected to achieve earlier recovery of postoperative visual acuity.

Surgical Treatment of Diabetic Recurrent Vitreous Hemorrhage and Traction Retinal Detachment

Although the irreversible proliferative complications of diabetes are less visible with anti-vascular endothelial growth factor (anti-VEGF) agents, surgical treatment is still important for these groups of patients; because of the high frequency of diabetes mellitus. The most common indications for vitreoretinal surgery for proliferative diabetic retinopathy are vitreous hemorrhages and tractional retinal detachments. This review summarized the surgical treatment of these two complications.

The protective effect of bandage contact lens on the cornea of diabetic patients during vitreoretinal surgery

Objective To observe the effect of bandage contact lens on epithelial after vitreoretinal surgery for proliferative diabetic retinopathy. Methods In this prospective, randomized, comparative clinical study, 60 eyes of 56 patients with PDR were randomly divided into two groups. They underwent vitreoretinal surgery. Group A, 29 eyes of 29 cases, the bandage contact lens were covered on corneal surface during surgery under noncontact wide-angle viewing systems. Group B, 31 eyes of 27 cases, the hydroxypropyl methylcellulose were covered on corneal surface during the same surgery. The corneal fluorescein sodium staining, tear function, count of corneal endothelium cells before and after operation were assessed. Results Pre-operation, corneal fluorescein staining positive rate was 41.38% in group A and 41.94% in group B (χ2=0.002, P=0.965). At 1, 2 and 3 d after surgery, the positive rate of group A was 44.83%, 41.37% and 37.93%, in group B was 70.97%, 70.97% and 67.74%, (χ2=4.212, 5.342, 5.350; all P<0.05). At 7 d after surgery, the positive rate was 41.37% in group A and 61.29% in group B (χ2=2.379, P=0.123). The BUT was (6.69±2.02)s in group A and (7.09±1.98)s in group B before surgery (t=-0.913, P=0.327). At 1, 2 and 3 d after surgery, the BUT of group A was (5.77±3.10)s, (5.91±2.64)s and (6.08±2.57)s, in group B was (4.49±3.42)s, (4.76±2.55)s and (5.18±2.31)s (t=3.279, 3.011, 2.259; all P<0.05). At 7 d after surgery, BUT was (6.28±2.41)s in group A and (5.67±2.51)s in group B (t=1.983, P=0.076). The difference of SchirmerⅠtest was not significant between two groups. Conclusion Bandage contact lens are used in vitreoretinal surgery for diabetic patients. Bandage contact lens superior to hydroxypropyl methylcellulose in the early postoperative corneal epithelial integrity and tear film stability. The bandage contact lens could protect the corneal epithelium during vitreoretinal surgery. Key words: Surgery, vitreoretinal; Retinopathy, diabetic, proliferative; Contact lens, bandage; Cornea; Wide-angle viewing, noncontact

Vitreoretinal surgery for proliferative diabetic retinopathy with two types of bandage contact lenses: clinical results and protection of corneal epithelium

Vitreoretinal surgery for proliferative diabetic retinopathy with two types of bandage contact lenses: clinical results and protection of corneal epithelium

Intraoperative OCT-assisted Surgery for Proliferative Diabetic Retinopathy in the DISCOVER Study

To delineate the feasibility and role of intraoperative optical coherence tomography (iOCT) in surgical decision-making during vitreoretinal surgical interventions for proliferative diabetic retinopathy (PDR). Prospective, single-site, multi-surgeon consecutive case series. Patients enrolled in the DISCOVER study who underwent vitreoretinal surgery for sequelae of PDR. Subjects were identified from the first 2 years of the DISCOVER study that underwent vitreoretinal surgery for complications of PDR. Intraoperative imaging with a microscope-integrated iOCT system was performed at surgical milestones as determined by the surgeon. Data collected included clinical characteristics, image features, and survey-based surgeon feedback. Main outcomes were 1) the percentage of cases with successful acquisition of iOCT (feasibility) and 2) the percentage of cases in which iOCT altered surgical decision-making (utility). Eighty-one eyes with PDR underwent vitreoretinal surgery in the DISCOVER study. Successful iOCT imaging was obtained for 80 of 81 eyes (98.8%). Of these, 36 (44.4%) were female and 44 (54.3%) were male. The surgeon preferred real-time feedback in 47 cases (58.6%), static review in 29 cases (36.3%), and was indeterminate in 4 cases (5%). Surgeons reported that in 2 cases (2.5%) the iOCT interfered with the surgery (e.g., microscope malfunction). In 41 of the 81 cases (50.6%), surgeons reported that iOCT provided valuable information (e.g., identification of dissection planes, identification of retinal hole). In addition, the iOCT data provided information that specifically altered the surgeon's decision making (e.g., determination of peel completion, choice of tamponade) in 21 of 81 cases (26%). No adverse events were attributed to the iOCT system. The results suggest that iOCT is feasible during complex vitreoretinal surgeries in patients with PDR using a microscope-integrated OCT platform. Utilizing intraoperative OCT, appears to frequently offer key information that may impact surgical decision-making and potentially patient outcomes.

Long-Term Survival Rates of Patients Undergoing Vitrectomy for Proliferative Diabetic Retinopathy

ABSTRACTPurpose: Reported 5-year survival rates in patients undergoing vitreous surgery for proliferative diabetic retinopathy (PDR) range from 68–95%. Studies relating survival rates to medical baseline characteristics predate the millennium. This study aimed to update data on life expectancy of patients undergoing vitrectomy for PDR and identify baseline factors which may influence survival.Methods: A retrospective cohort study of consecutive patients who underwent their first pars-plana vitrectomy for PDR between April 2004 and May 2005 was performed. Survival status on 1 May 2012 was the primary endpoint. The Kaplan-Meier life table method was used to determine survival rates. Univariate and multiple variable Cox proportional hazards regressions were used to identify risk factors for mortality.Results: A total of 148 patients were included in the study, with a mean age of 54 years (range 20–80 years) at time of surgery. The 3-, 5- and 7-year survival rates were 94%, 86% and 77%, respectively (95% confidence interval, CI, 88–97%, 79–91% and 68–84%, respectively). Renal failure was the most common cause of death. The presence of limb ulcers at baseline was the most important prognostic indicator for mortality, with a hazard ratio of 3.13 (95% CI 1.46–6.71, p = 0.003) and a survival rate at 5 years reduced to 79%.Conclusion: The 5-year survival rate remains comparable to those reported 20 years ago despite a lowering in threshold for vitrectomy and increased health awareness. Limb ulcers are strongly associated with increasing mortality. Clinicians should remain mindful of the systemic associations of diabetes particularly in advanced retinal disease.

The kinetics of VEGF and MCP-1 in the second vitrectomy cases with proliferative diabetic retinopathy.

PurposeTo determine whether the concentrations of vascular endothelial growth factor (VEGF) and monocyte chemoattractant protein (MCP)-1 in the vitreous changed after vitrectomy in patients with proliferative diabetic retinopathy (PDR).ParticipantsTwenty-one eyes of 21 patients who needed a second surgery for PDR were included. The reasons for the second surgery were tractional retinal detachment (TRD), neovascular glaucoma, persistent vitreous hemorrhage, macular pucker, and secondary intraocular lens (IOL) implant.MethodsWe measured the VEGF and MCP-1 levels using sandwich enzyme-linked immunosorbent assays in vitreous samples collected from patients with PDR before pars plana vitrectomy (without IOL implantation), and from the same patients during the second surgery.ResultsThere was not significant change in mean VEGF concentrations when comparing first (0.81±0.88 ng/ml) and second surgeries (1.09±1.51 ng/ml). The MCP-1 level was significantly elevated at the time of second surgery (2.20±2.21 ng/ml) compared with the first vitrectomy (0.72±0.57 ng/ml). The MCP-1 levels of the second surgery cases with TRD (3.18±2.27 ng/ml) increased significantly compared with those with other complications (1.72±2.10 ng/ml).ConclusionsAt the second vitrectomy, VEGF did not change significantly in the vitreous of the patients examined. The MCP-1 concentration was markedly elevated at the second vitrectomy, implying an association between the prolonged inflammation after vitrectomy and complications, especially TRD.