The choice of tamponade of vitreous cavity in managing hemorrhagic complications of patients with different stages of proliferative diabetic retinopathy

Session Details

Session Title: Free Paper Session 28: Vitreoretinal Surgery VII

Session Date/Time: Sunday 10/09/2017 | 12:00-13:30

Paper Time: 12:24

Venue: Room 116

First Author: : M.Kalanov RUSSIA

Co Author(s): :    R. Fayzrakhmanov   M. Bikbov   R. Zaynullin   V. Salavatova                    

Abstract Details

Purpose:

To compare the efficiency of tamponade of vitreous cavity by gas-air mixture (C2F6, Acreole) or silicone oil (5700сS, Oxane®, Syringe) in managing haemorrhagic complications of patients with different stages of proliferative diabetic retinopathy.

Setting:

Ufa Eye Research Institute, Ufa, Russia.

Methods:

The study included 112 patients (112 eyes) with the proliferative stage of diabetic retinopathy, compensated (subcompensated) type II diabetes mellitus, the significance of glycohaemoglobin (HbA1c) ≤ 8.0%. The mean age was 62 ± 5 years. There were 72 women (64.3%), and 40 (35.7%) men. All patients were divided into 2 main groups: the first group consisted of 32 patients (32 eyes) with an early stage of proliferative diabetic retinopathy. After vitrectomy, the vitreous cavity was tamponed by gas-air mixture. The second group consisted of 80 patients (80 eyes) with advanced stage of proliferative diabetic retinopathy. The 2nd group was divided into 2 subgroups: Subgroup 2.1 comprised 37 patients (37 eyes) who had gas-air tamponade applied. Subgroup 2.2 consisted of 43 patients (43 eyes) with a silicone oil tamponade after vitrectomy. All patients had cataract phacoemulsification with IOL implantation prior to enrollment, and an intravitreal injection of an anti-VEGF preparation was performed in 8-10 days before vitrectomy. The visual acuity before vitrectomy in patients of Group 1 averaged 0.44. In group 2, it was 0.17. The follow-up period was 1 year. Statistical processing of data was carried out using the IBM SPSS statistics program.

Results:

Intraoperative haemorrhagic complications in group 1: minor – 14 (43.7%), without complications – 18 (56.3%). Fibroglial tissue was removed in all cases. Recurrences of preretinal haemhorrages were observed in 9 patients (28.1%): in early postoperative period – 2 patients (6,2%), in long-term – 7 (21.9%). Additional vitreoretinal surgery including lavage of the vitreous cavity with silicone tamponade – for 4 (45.5%). Stabilization of the process after primary vitrectomy was observed in 23 patients (71.9%), after one year in the eyes with avitria – in 32 (100.0%). The following intraoperative haemorrhagic complications in group 2 (subgroup 2.1 / subgroup 2.2, overall percentage of group 2) were seen: minor – 6/12 (22.5%), moderate - 26/9 (44.0%), insignificant - 5/21 (32.5%). Local tractional retinal detachment - 24/12 (45.0%); Complete removal of fibroglial tissue – in 21/31 (65.0%), partial –in 28 (35.0%). Recurrences of haemhorrages after vitrectomy at early postoperative period – 23/1 (30,0%), in long-term - 5/0 (6,2%); Additional vitreoretinal surgery – 19/43 (77.5%); recurrence of haemhorrages after additional vitreoretinal surgery – 8/12 (25.0%); stabilization of process in the eyes with avitia after one year –23/39 (77.5%); оn silicone oil after one year - 4/4 (10,0%); after a primary vitrectomy – 9/0 (11.25%).

Conclusions:

1. The primary vitrectomy followed by a gas-air tamponade is the most effective procedure in early stages of proliferative diabetic retinopathy according to the low number of intraoperative and postoperative haemorrhagic complications. Stable result in avitrial eyes after primary vitrectomy was noted in 71.9% of cases, it was 100% after one year of follow-up; 2. The use of a gas-air mixture after primary vitrectomy in patients with advanced stage of proliferative diabetic retinopathy is a less effective way of tamponade of vitreous cavity in the managing of haemorrhagic complications, and it was successful only in 11.25% of cases; 3. The use of silicone oil after primary vitrectomy is the most effective (97.6%) method of tamponade of vitreous cavity in haemorrhagic complications at the advanced stage of proliferative diabetic retinopathy, but in all cases it is necessary to perform an additional vitreoretinal surgery in order to remove silicone oil. 4. Surgical treatment of the advanced stage of proliferative diabetic retinopathy is accompanied by repeated additional vitreoretinal interventions, the use of heavy substitutes of vitreous body and decrease of functional results.

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