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Modified bimanual microincision vitreous surgery for severe proliferative diabetic retinopathy

Session Details

Session Title: Vitreoretinal Surgery III

Session Date/Time: Friday 27/09/2013 | 11:00-12:30

Paper Time: 11:08

Venue: Hall 3 (Level 0)

First Author: C.Gupta INDIA

Co Author(s):    C. Shroff   A. Singh   N. Atri   D. Shroff     

Abstract Details

Purpose:

To analyze the visual and anatomical results and complication rate after modified bimanual microincision vitreous surgery(MIVS) for severe proliferative diabetic retinopathy.

Setting:

Retrospective ,interventional case study at a tertiary centre

Methods:

Retrospective analysis of 156 eyes of 127 patients who underwent modified transscleral bimanual MIVS surgery for severe proliferative diabetic retinopathy from January 2008 to July 2012. Indications for surgery were, vitreous haemorrhage with extramacular TRD(48%), macular TRD (32%), combined RD(14%) and severe fibrovascular proliferation (6%). Modifications in the surgical procedure were transscleral introduction of 23gauge trocar-cannula, twin torpedo light placement at 12 o’clock and 6 o’clock and closure of sclerotomies at closure. Complete base excision with depression, bimanual delamination of membrane with wide angle viewing system or Landers contact lens system and laser photocoagulation was done in all cases. Combined phaco-vitrectomy was done in 52% of eyes and cataract wound was sutured in all cases. Visual acuity, IOP, retinal status and postoperative complications were analyzed at baseline, 6 weeks, 3months, 6 months, 1year and at last follow up.

Results:

Overall visual acuity improved in 86% of eyes, was stable in 7% and worsened in 7%. At 6 months postoperative follow up ,74% of eyes had a visual acuity of 20/ 200 or better compared to 22% of preoperative eyes (p < 0.006). At the same follow up 22% of eyes had a visual acuity of 20/ 40 or better compared to no eye preoperatively. Mean logMAR preoperative vision was 1.76 and postoperative logMAR vision at 6wks, 3 months, 6months , 1year and last follow up was 1.08, 1.00, 0.84, 0.85 and 0.68 respectively ( p values <0.01 at all follow ups). Rebleed rate was 11.5% at 6 weeks, , 7.7% at 3 months, 3.2 % at 6months and 2.6% at 1year follow up. 13 of 156 eyes (8.3%) required further intervention; 11 ( 7%) eyes for persistent postoperative vitreous haemorrhage and 2 eyes (1.3%) for retinal detachment with reproliferation of membranes. No significant increase in anterior or posterior segment complications was seen with combined phaco-vitrectomy. Vision improvement was most commonly limited by pale optic disc (14%). 2 eyes(1.3%) had intractable glaucoma and 1eye(0.6%) had severe reproliferation of membranes.

Conclusions:

The modifications in the surgical procedure helped us achieve complete base excision and relief of peripheral traction decreasing chances of recurrent bleed, retinal detachment and anterior hyaloid fibrovascular proliferation. Twin torpedo lights gave excellent illumination enabling better bimanual dissection.Suturing of sclerotomies avoids hypotony in these already complex cases. Combined phaco-vitrectomy helps in achieving our surgical objectives better without any increase in complication rate. Good visual and anatomical results were achieved in most cases. Limited visual recovery in some of the cases was attributed to compromised optic nerve functioning rather than surgical complications

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