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Peculiarities of safe vitrectomy in proliferative diabetic retinopathy

Session Details

Session Title: Quick Fire Free Paper Session 03

Session Date/Time: Sunday 29/09/2013 | 08:30-09:30

Paper Time: 08:30

Venue: Hall C (Level 1)

First Author: O.Sinyavskiy RUSSIA

Co Author(s):    R. Troyanovskiy   A. Golovin   V. Ilyushchenkov   A. Astapenko     

Abstract Details

Purpose:

To analyze steps and features of vitrectomy in severe proliferative diabetic retinopathy (PDR) for decreasing the rate of immediate and late complications.

Setting:

The technique of vitrectomy in PDR remains difficult with the relatively high risk of complications, so standardization of this operation is very important.

Methods:

High speed vitrectomy 23G and 25G was performed in 108 patients (117 eyes, 76 female, 32 males with average age 54 years). Follow-up period ranged from 6 months till 4 years. A removal of vitreous gel, blood and posterior hyaloid membrane in the sites of posterior vitreous detachment (PVD) not from optic nerve head was the first step of vitrectomy - a primary general segmentation with localization dangerous epicenters with fibrovascular membranes and retinal detachment, where PVD was absent as a rule. Then we removed peripheral and basal hyaloid. Next step was detachment and ablation of presumed residual vitreous cortex (seemed like thin “arachnoid” preretinal membrane) from the retinal surface around epicenters with subsequent secondary careful segmentation, delamination and removal of fibrovascular membranes. Maculorexis was performed in cases without macular retinal detachment for prophylaxis of macular fibrosis and edema. Different vitreous and retinal samples were undergone histological study. In the most cases additional central and peripheral lasercoagulation was necessary. Green (532 nm) endolaser used for hemostasis. Drug support: lucentis before operation and tranexamic acid 1000 mg intravenously during operation.

Results:

Positive results with increasing or stabilization of visual acuity (including additional operations) were obtained in 103 eyes (88 %). In 98 eyes (83,7%) air or gas were used as vitreous substitude in the end of operation. In 9 cases (9 eyes) we noticed impairment of visual acuity. Vision was failed in 5 eyes after recurrent retinal detachments and secondary glaucoma. Different immediate and late complications were revealed - retinal detachment in 7 eyes, recurrent hemorrhages in 15 eyes, optic nerve atrophy in 12 eyes, secondary drug-resistant glaucoma in 6 eyes.

Conclusions:

Described stereotype of vitrectomy in PDR makes it possible to decrease the rate of complications and refuse to silicone oil injection in the most cases. Indications for silicone oil tamponade were only retinal tears with risk of retinal detachment and severe recurrent hemorrhage. Detachment and removal of residual vitreous cortex facilitate segmentation and delamination of fibrovascular membranes, reduce retinal tears formation and protect optic nerve head. We always avoided active initiation of PVD and en block technique. Peripheral lasercoagulation, maculorexis and drug support are very important also.

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