Vitrectomy In Diabetic Patients Research Articles

Gestion médicochirurgicale de l’hémorragie intravitréenne chez le patient diabétique

Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.

Use of commercially available sodium hyaluronate 0.18% eye drops for corneal epithelial healing in diabetic patients.

To evaluate the effect of topical sodium hyaluronate (SH) 0.18% treatment on corneal epithelial healing after epithelial debridement in pars plana vitrectomy in diabetic patients. This is prospective and randomized clinical trial. Our study population included 30 eyes undergoing pars plana vitrectomy that required near total corneal debridement intra-operatively for surgical view. We compared the residual wound and wound healing rate in between 3 groups: 10 diabetic eyes (DMV) on topical SH 0.18%; 10 diabetic eyes (DMC) and 10 non-diabetic eyes (NDM) not treated with topical SH 0.18%. The corneal epithelial wound was measured at 12, 24, 36, 48, 60, 72 and 120h after the vitrectomy surgery. DMC group had corneal wounds that reepithelialization significantly more slowly than in NDM and DMV groups at 12, 24, 36 and 48h (Mann-Whitney test p < 0.05). The epithelial healing rate was significantly faster at 12h in NDM and DMV group (Mann-Whitney test p < 0.05). No differences in the residual epithelial wound and wound healing were detected in between NDM and DMV groups. The mean for epithelial closure in DMC group was delayed 87.6 ± 28.31h, compared with DMV group (64.8 ± 21.31) and NDM group (56.4 ± 9.88). All groups were followed up 1month beyond completed wound closure. No recurrent corneal epithelial wound, corneal melting or corneal neovascularization was noted. Diabetic patients on SH 0.18% four times daily for epithelial defect had similar corneal wounds healing rate as non-diabetics. This treatment significantly improved corneal wound healing and accelerated complete corneal wound resurfacing in diabetic patients.

Research progress of diabetic keratopathy

With the increase of diabetes mellitus, the incidence of diabetic complications has gradually attracted the attention of researchers.Long-term hyperglycemia has toxic effects on cells and tissues in the body, and its most profound effects on eye tissue are the cornea and retina.Clinicians begin to focus on diabetic keratopathy since the occurrence of corneal epithelial lesions after vitrectomy in diabetic patients, and find that hyperglycemia causes damage of different degrees to each layer of the corneal structure by changing the corneal morphology, metabolism and physiology, including corneal epithelium, corneal nerves, tear film and endothelium.Diabetes mellitus results in clinical abnormalities that are referred to as diabetic keratopathy.This review mainly focused on the pathogenesis, clinical features and treatment of diabetic keratopathy. Key words: Diabetes mellitus; Cornea; Pathogenesis; Clinical features; Treatment

Comparison of clinical outcome between 23-G and 25-G vitrectomy in diabetic patients.

PURPOSE:To compare the clinical outcomes and complications between 23-G and 25-G vitrectomy in patients with diabetic vitreous hemorrhage (VH).MATERIALS AND METHODS:A retrospective comparative study comprising 69 eyes (36 eyes in 23-G group and 33 eyes in 25-G group) of 65 patients who underwent vitrectomy with air tamponade for diabetic vitreous hemorrhage (VH) with at least 6 months of follow-up was conducted.RESULTS:There were no significant differences between the two groups in age, gender, bilaterality, type of diabetes, presence of hypertension, lens status, and previous argon laser photocoagulation state (P > 0.05). Best-corrected visual acuity (BCVA) of both groups at postoperative 1 month logarithm of the minimum angle of resolution (logMAR) (1.06 ± 0.99, 0.90 ± 0.96), 3 months logMAR (1.07 ± 0.93, 0.83 ± 0.85), and 6 months logMAR (1.03 ± 0.89, 0.83 ± 0.85) significantly improved from the preoperative BCVA logMAR (2.03 ± 0.83, 2.15 ± 0.99) for 23-G group, 25-G group, respectively (P < 0.0001). There was no significant difference in BCVA between the two groups preoperatively and at 1, 3, and 6 months postoperatively (P = 0.566, 0.506, 0.333, and 0.445, respectively), incidence of intraoperative wound suturing (21.4%, 15.2%), postoperative hypotony (0.0%, 0.0%), early postoperative VH (POVH) (11.1%, 15.2%), late POVH (5.6%, 0.0%), retinal detachment (2.8%, 6.1%), neovascular glaucoma (92.8%, 9.1%), and endophthalmitis (0.0%, 0.0%) for 23-G group, 25-G group, respectively (P > 0.05).CONCLUSION:25-G vitrectomy is as effective for PDR as 23-G vitrectomy.

Improved outcome after primary vitrectomy in diabetic patients treated with statins.

To evaluate the effect of preoperative statin treatment on the outcome of primary vitrectomy in type 1 and 2 diabetic patients. In this open, observational institutional study, a total of 192 eyes of 171 type 1 and 2 adult diabetic patients admitted for primary vitrectomy for management of sight-threatening forms of diabetic retinopathy were divided according to the use of lipid-lowering therapy: those with statin treatment (79 eyes of 73 patients) and those taking no statin medication (113 eyes of 98 patients). One-month best-corrected visual acuity (BCVA) gain and cumulative 12-month revitrectomy frequency were analyzed. In multivariate linear regression, diabetic patients with statin treatment had a better 1-month BCVA improvement than did those without statin treatment (absolute difference 0.26, 95% confidence interval [CI] 0.02-0.50, p = 0.028). Subgroup analysis revealed that diabetic patients on statin had better postoperative BCVA improvement when preoperative status included partial or panretinal laser photocoagulation (p = 0.042 and p = 0.049) and anti-vascular endothelial growth factor therapy (p = 0.011). Moreover, diabetic patients with preoperative macular edema (p = 0.009), vitreous hemorrhage (p&lt;0.001), proliferative retinopathy (p&lt;0.001), or tractional retinal detachment (p = 0.010) had better BCVA recovery if receiving statin. In Cox proportional hazards regression model, revitrectomies in our 12-month follow-up were less frequent in diabetic patients on statin treatment (hazard ratio 0.28, 95% CI 0.08-0.93, p = 0.037). These data provide novel insight into the potential clinical benefit for patients with sight-threatening diabetic retinopathy undergoing vitrectomy treated with statin.

Improved outcome after primary vitrectomy in diabetic patients treated with simvastatin

AbstractPurpose Simvastatin treatment may reduce intravitreal levels of potent vasoactive, angiogenic, and fibroproliferative factors. Here, we evaluated the effect of preoperative simvastatin treatment on the outcome of primary vitrectomy in diabetic patients.Methods Prospective, observational case control study of type 1 and 2 adult diabetic patients admitted for primary vitrectomy in management of sight‐threatening forms of diabetic retinopathy (DR). A 1‐month best corrected visual acuity (BCVA) gain and cumulative 12‐month re‐vitrectomy frequency of 192 diabetic patients, 79 on simvastatin treatment and 113 without any statin medication.Results Diabetic patients with simvastatin treatment had a better 1‐month BCVA improvement than did those without statin treatment (p=0.009). Subgroup analysis revealed that diabetics on simvastatin had better post‐operative BCVA improvement when preoperative status included partial or panretinal laser photocoagulation (p=0.042 and p=0.049) and anti‐VEGF therapy (p=0.011). Moreover, diabetics pre‐operatively with macular edema (p=0.009), vitreous hemorrhage (p&lt;0.001), proliferative retinopathy (p&lt;0.001), or tractional retinal detachment (p=0.010) had better BCVA recovery, if receiving simvastatin. Our 12‐month follow‐up revealed that the frequency of revitrectomies (p&lt;0.001) and re‐revitrectomies (p=0.016) were lower in diabetics on simvastatin treatment.Conclusion These data provide novel insight into the potential clinical benefit for patients with sight‐threatening DR undergoing vitrectomy treated with simvastatin.

This issue of ACTA, printed and electronic

This issue of <i><scp>ACTA</scp></i>, printed and electronic

Preoperative Electroretinogram and PostoperativeVisual Outcome in Patients with Diabetic Vitreous Hemorrhage

Purpose: To determine whether the single-flash electroretinogram (ERG) can predict the postoperative outcome in diabetic cases where massive vitreous hemorrhage precludes fundus observation. Methods: Eighty-five diabetic patients (105 eyes) who underwent vitrectomy due to dense vitreous hemorrhage were studied retrospectively. Eyes with postoperative complications were excluded. Preoperative ERGs (mixed cone-rod ERG with maximum flash intensity) were classified as: Group A, the b-wave/a-wave ratio (b/a ratio) was ≥1.0 and the oscillatory potentials (OPs) were clearly recordable (22 eyes); Group B, the b/a ratio was ≥1.0 and the OPs were markedly reduced (33 eyes); and Group C, the b/a ratio was <1.0 (50 eyes). Results: The postoperative visual acuity in Group C (hand motion to 1.5) was significantly worse than in Group A (0.4–.2) ( P<.01) or Group B (0.08–1.0) ( P<.01). Thick preretinal membrane causing retinal traction around the optic disc was found intraoperatively in 1 eye (4.5%) in Group A, 9 eyes (27.3%) in Group B, and 28 eyes (56.0%) in Group C ( P = .0132). Conclusion: Our findings suggested that the configuration of the single-flash ERG can provide important preoperative information for a functional prognosis following vitrectomy in diabetic patients with vitreous hemorrhage.

Effect of pars plana vitrectomy for proliferative diabetic vitreoretinopathy on preexisting diabetic maculopathy.

Vitrectomy is the treatment of choice for proliferative diabetic vitreoretinopathy with tractions and persistent vitreous hemorrhage. Since vitrectomy has recently been discussed as a possible therapy for diabetic maculopathy as well, we were especially interested in studying the change in diabetic maculopathy following surgery. For that purpose a grading system developed at our clinic was used. In a retrospective study we evaluated fundus photographs and fluorescein angiograms of 33 eyes of 30 patients who had undergone vitrectomy for proliferative diabetic vitreoretinopathy at our clinic between 1990 and 1997. In all eyes diabetic maculopathy was present at the time of surgery. The grading was performed using preoperative images and images taken a median of 18 months postoperatively. Best corrected visual acuity increased by 3.7 lines on average. Intraretinal dot and spot hemorrhages, hard exudates, microaneurysms on fundus photos, and leakage and cysts on fluorescein angiograms decreased after surgery. The extent of the foveolar avascular zone and the extent of the perifoveolar ischemic area worsened, however. Vitrectomy seems to help diabetic eyes not only by removal of membranes, tractions, and vitreous hemorrhage; it seems to have a positive influence on the course of diabetic maculopathy as well. We suspect that the removal of the posterior vitreous membrane is one of the crucial factors in interrupting the disease process. From these results the indication for vitrectomy in diabetic patients may have to be reconsidered and extended to include diabetic maculopathy prior to the development of ischemia.

Factors Contributing to Corneal Complications After Vitrectomy in Diabetic Patients

Purpose: To elucidate factors contributing to corneal complications after vitrectomy in diabetic patients. Methods: The records of a series of 129 diabetic patients (202 eyes) who underwent pars plana vitrectomy performed by a single surgeon between March 1997 and February 1999 were analyzed retrospectively. Logistic regression analysis was performed to determine possible factors contributing to corneal complications. Results: Of the 202 eyes, 102 (50.5%) developed corneal complications after surgery; 90 (44.6%) had epithelial disturbance; and 48 (23.8%) had corneal edema. The degree of surgical invasion during vitrectomy was significantly correlated with the occurrence of epithelial disturbance and corneal edema. Conclusion: Surgical invasion is a risk factor for corneal complications after vitrectomy in diabetic patients.

Vitrectomy in diabetic patients with a blind fellow eye

Results of pars plana vitrectomy for complications of proliferative diabetic retinopathy were analysed in 32 consecutive patients with a blind fellow eye due to diabetic eye disease. The mean follow-up period was 22.3 months. Only 16% of all eyes examined had received full scatter photocoagulation prior to referral for vitrectomy. Out of 9 eyes with vitreous haemorrhage, 8 improved to a visual acuity of > or = 0.2 postoperatively. Amid 23 eyes which were vitrectomized for advanced traction retinal detachment, only 4 eyes improved to a postoperative visual acuity of > or = 0.02. In this group 12 eyes deteriorated after vitrectomy, 3 eyes progressing to no light perception. The postoperative visual outcome after vitrectomy for traction retinal detachment in this group of diabetics with a blind fellow eye (mean postoperative visual acuity 0.03 +/- 0.05) was significantly worse (p < 0.000) compared to a group of 196 patients with a seeing fellow eye who were vitrectomized for traction retinal detachment at our clinic (mean postoperative visual acuity 0.09 +/- 0.11). Therefore we conclude that traction retinal detachment in this subgroup of patients is a particularly severe presentation of diabetic retinopathy with a guarded functional prognosis after vitrectomy. Our results demonstrate the importance of timely full scatter photocoagulation and early vitrectomy in eyes with progressive fibrovascular proliferation not responding to panretinal photocoagulation. We conclude that especially diabetic patients with a blind fellow eye must be followed closely and assigned to vitrectomy at an earlier stage of their disease in order to improve functional prognosis.

Long-term retention of vision following vitrectomy in diabetic patients.

Life-term analysis of 117 patients who underwent pars plana vitrectomy surgery showed that immediate improvement in vision postoperatively was demonstrated in 66% of the patients. This visual acuity, designated usable vision, persisted throughout a 7-yr follow-up period in 46% of the original patients undergoing surgery. It was concluded that vitrectomy surgery can be useful in the preservation of vision if the cases are carefully selected for the operation.