Cheri T Colagross | PubMed Health

PubMed2006

Diabetic vitrectomy: risks, prognosis, future trends.

PURPOSE OF REVIEW: We review the current standards, risks, prognosis, and indications for diabetic pars plana vitrectomy and consider recent developments in surgical techniques. We also examine surgery's role as a treatment modality for diabetic eye disease among the other accepted and developing treatment options, such as systemic and intravitreal pharmacotherapy. RECENT FINDINGS: Pars plana vitrectomy for diabetic macular edema and for traction retinal detachment is addressed. Techniques to decrease retinal swelling and ischemia are showing promising results. The use of the smaller 25-gauge and 23-gauge vitrectors is gaining acceptance and offers advantages such as less trauma, less postoperative discomfort, and quicker healing. Techniques are being developed and refined to help prevent postoperative vitreous hemorrhage using cryotherapy around sclerotomy sites and/or endolaser in a near-confluent pattern in an effort to quell fibrovascular ingrowth and subsequent hemorrhage. Finally, pharmacological advances include targeting three levels of intervention: achieving the best glycemic control, correcting altered retinal metabolism secondary to increased glucose availability, and employing neuroprotective and vasoprotective agents. SUMMARY: The combination of therapies and interventions as they improve and evolve offers the potential to revolutionize the approach to the complications of diabetic eye disease and may soon render many current interventions obsolete. Diabetic pars plana vitrectomy continues to advance with better anatomic and visual success.

Diabetic Retinopathy↗

PubMed2005

Visual outcome and risk factors for light perception and no light perception vision after vitrectomy for diabetic retinopathy.

PURPOSE: To assess the visual outcome following vitrectomy for diabetic retinopathy compared with previous studies; to evaluate risk factors for light perception (LP) and no light perception (NLP) vision after diabetic vitrectomy. DESIGN: Retrospective medical record review. METHODS: The charts of 100 consecutive patients who underwent vitrectomy for proliferative diabetic retinopathy between November 1, 1997, and November 30, 1998, were reviewed. Surgical technique included standard pars plana vitrectomy with combination of delamination and segmentation of gliotic tractional membranes using bimanual techniques. All patients had post-operative follow-up of at least 12 months. Several factors were analyzed for their effect on poor visual outcome (LP and NLP) using Fisher's exact test. RESULTS: Post-vitrectomy, 73% of diabetic patients had stable or improved vision; 16% had worsened but functional vision, defined as worse but still >or= 20/400; 4% had worsened but ambulatory vision, defined as worse but still count fingers (CF) or hand motion (HM); and 7% had poor visual outcome, LP or NLP. Resultant visual acuity was >or=20/40 in 38% of patients, 20/50 to 20/100 in 34%, 20/120 to CF in 18%, HM in 3%, LP in 4%, and NLP in 3%. Risk factors for eyes with LP and NLP vision included pre-operative iris neovascularization (INV), P = .05, post-operative INV, P = .02, post-operative macular ischemia, P = .0001, and post-operative vitreous hemorrhage (VH), P = .02. CONCLUSIONS: Pre-operative and post-operative INV, post-operative macular ischemia, and post-operative VH appear to be risk factors for LP and NLP vision following diabetic vitrectomy, whereas overall improvements in surgical technique and visual outcome continue to be reported.

Adult↗