Surgical outcome of 27G pars plana vitrectomy for proliferative diabetic retinopathy

Session Details

Session Title: Free Paper Session 26: Vitreoretinal Surgery VI

Session Date/Time: Sunday 10/09/2017 | 10:00-11:30

Paper Time: 10:18

Venue: Room 116

First Author: : S.Mittal INDIA

Co Author(s): :    K. Madaan                             

Abstract Details

Purpose:

To evaluate the surgical outcomes and complications of 27 gauge (27G) Pars Plana Vitrectomy (PPV) for complications of Proliferative Diabetic Retinopathy (PDR)

Setting:

Thind Eye Hospital, Jalandhar

Methods:

Retrospective review of 94 eyes with Proliferative Diabetic Retinopathy which underwent 27G PPV between 1st January 2016 and 31st December 2016 were included. All eyes were operated by a single surgeon. There were 34 eyes with Vitreous haemhorrage and Tractional Retinal Detachment (TRD), 27 eyes with TRD alone, 6 eyes with combined Retinal Detachment, 5 eyes with severe PDR, 14 eyes with tractional Diabetic Macular Edema and 8 eyes with subhyaloid haemhorrage. A 3 port sutureless 27G pars plana vitrectomy was done. The core vitrectomy performed. A modified en-bloc dissection was done after separating the post hyaloid at the disk using an end gripping forceps. The pre-retinal membranes were removed using vitreous cutter alone. Internal Limiting Membrane peeling using indocyanine green & Laser pan-retinal photocoagulation was done wherever needed. Silicone Oil was used as a tamponade agent in 8 eyes whereas 20% Sulfur hexafluoride gas was used in 8 eyes, 14% Perfluoro-OCT-Ane in 9 eyes. Outcome measures evaluated were anatomical success, best corrected visual acuity, Intra-Ocular Pressure (IOP) & Intra-operative or postoperative complications.

Results:

Successful anatomical outcome with single surgery was achieved in 92/94 eyes. Bimanual surgery was not needed in any eye. The membrane dissection was possible with vitrectomy cutter alone in 82/94 eyes. Iatrogenic breaks during membrane dissection occurred in11 eyes. Improvement in best corrected visual acuity was seen in 85 eyes. Early vitreous cavity haemhorrage was seen in 13 eyes. One eye needed a repeat surgery after 6 weeks for non-clearing vitreous haemhorrage. Delayed onset vitreous cavity haemhorrage was seen in 3 eyes. Transient rise in IOP was seen on 1st postoperative day in 27 eyes which was controlled on topical medications. 13 eyes had hypotony on 1st postoperative day and 11 of them had choroidal detachment. Additional 25G sclerotomy was needed to inject silicon oil in 8 eyes. Silicon oil was removed after 2 months of first surgery. 1 eye had re-detachment 2 months after surgery for which re-surgery was done.

Conclusions:

27G PPV offers increased wound stability, easier entry & less trauma to ocular surface. It results in more postoperative comfort & early rehabilitation of patients. Smaller wound size results in less incidence of wound leakage, vitreous incarceration & hypotony which in turn minimizes the chance of postoperative infection. Small sphere of influence of 27G vitrectomy cutter avoids retinal tissue be engaged in port while dissecting membranes. Thin cutter allows it to go in even smaller crevices for effective membrane dissection. Large opening of cutter which is nearer to tip makes it easier to grasp, peel and dissect all types of membranes.

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