Institutional members access full text with Ovid®

Share this article on:

VISUAL AND ANATOMICAL OUTCOMES AFTER DIABETIC TRACTION AND TRACTION-RHEGMATOGENOUS RETINAL DETACHMENT REPAIR

Storey, Philip, P., MD, MPH*,†; Ter-Zakarian, Anna, MS*; Philander, Shannon, A., MD*; Olmos de Koo, Lisa, MD, MBA*,‡; George, Meena, MD, PhD*; Humayun, Mark, S., MD, PhD*; Rodger, Damien, C., MD, PhD*; Ameri, Hossein, MD, PhD, FRCSI, MRCOphth*

doi: 10.1097/IAE.0000000000001793
Original Study: PDF Only

Purpose: To evaluate visual and anatomical outcomes of diabetic tractional retinal detachment repaired with pars plana vitrectomy.

Methods: Operative records were used to retrospectively identify all patients with tractional retinal detachments secondary to proliferative diabetic retinopathy surgically repaired with pars plana vitrectomy between November 1, 2009, and January 1, 2015 at the LAC + USC (Los Angeles County + University of Southern California) Medical Center.

Results: A total of 403 eyes with diabetic tractional retinal detachment in 359 patients were included. Successful reattachment of the retina was achieved in 87.6% of eyes after one surgery and 92.6% of eyes at the final follow-up. Best-corrected visual acuity at the final follow-up improved two or more lines in 56.3% of eyes, was stable in 23.8% of eyes, and decreased two or more lines in 19.9% of eyes. Eyes repaired with 23-gauge and 25-gauge vitrectomy systems had similar success rates as eyes treated with 20-gauge instrumentation (P = 0.73). Eyes receiving silicone oil tamponade had lower single-surgery reattachment rates (77.6% vs. 87.6%; P = 0.013), lower reattachment rates at the final follow-up (85.7% vs. 92.6%; P = 0.048), and higher rates of vision loss (34.7% vs. 19.9%; P < 0.0001) but were more likely to have concurrent rhegmatogenous detachment (47.0% vs. 21.3%; P < 0.0001) and macula involving detachment (74.5% vs. 60.0%; P < 0.0001).

Conclusion: In this large, single-center retrospective study of patients with advanced diabetic tractional retinal detachment, vitrectomy achieved excellent anatomical outcome and improved or stabilized vision in 80.1% of eyes. Smaller gauge vitrectomy systems were found to have similar outcomes to 20-gauge instrumentation.

In a study of 403 eyes with diabetic tractional retinal detachments, eyes repaired with pars plana vitrectomy using 20-, 23-, and 25-gauge systems had similar outcomes with success rates above 90% for all 3 systems and visual acuity stabilization or improvement in 80% of cases.

*USC Roski Eye Institute, University of Southern California, Los Angeles, California;

Wills Eye Hospital, Retina Service, Philadelphia, Pennsylvania; and

University of Washington Eye Institute, Seattle, Washington.

Reprint requests: Hossein Ameri, MD, PhD, FRCSI, MRCOphth, USC Roski Eye Institute, 1450 San Pablo Street, Los Angeles, CA 90033; e-mail: ameri@med.usc.edu

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.