Severe diabetic tractional retinal detachment treatment combined with pars plana vitrectomy and scleral buckling with intrasilicone oil injection of dexamethasone implant

Author: Utku Limon (Turkey)

Co-authors:

Purpose

To evaluate the efficacy and complications of intravitreal dexamethasone with simultaneous silicone tamponade after pars plana vitrectomy (PPV) with scleral buckling in a patient with severe diabetic tractional retinal detachment.

Setting/Venue

Surgical case

Methods

An 56 years old diabetic male patient applied to our clinic due to vision loss. His visual acuity was counting fingers from 1 meter in his right eye and hand motions in his left eye. Anterior segment examination revealed nuclear cataracts in the right and left eyes. Intraocular pressures were 12 and 13 mmHg in both eyes, respectively. In fundus examination there was tractional retinal detachment involving the macula and grade-1-2 vitreous hemorrhage in both eyes. The patient had no previous treatment for diabetic retinopathy. We planned PPV to his right eye after left eye. We treatted his left eye combined with phacoemulsification, PPV and scleral buckling.

Results

Intravitreal bevacizumab injection was applied to the patient 2 days before surgery. We used 23 gauge PPV settings. Bimanual surgery was performed. Most of the fibrovascular membranes pealed with using delamination, segmentation, and peeling techniques. Internal limiting membrane (ILM) was pealed (in an area of approximately 3 disc diameter). Scleral buckling surgery was added to PPV due to subretinal and preretinal bands that could not be removed in the peripheral retina. The retinal folded area in the superior temporal retina was not touched due to the risk of a tear. 360 degree pan-retinal laser photocoagulation was performed with indentation under the liquid perfluorocarbon after the retina was attached. 1000cst silicone oil was injected after liquid-air exchange. After the trocars were removed and sutured, dexamethasone implant was injected into silicone oil. The patient's visual acuity was counting fingers from 10 centimeters in the left eye at 2nd month. There was no inflammation in the patient in the early postoperative period. Proliferative vitreoretinopathy and recurrent retinal detachment did not develop during the 2-month follow-up. Intraocular pressure did not increase.

Conlusions

Conclusion: In our country, there are a small number of patients who have not received any treatment for diabetic retinopathy and developed severe tractional retinal detachment. Anatomical recovery can be achieved in these patients with careful surgery, but it is difficult to achieve functional success. Postoperative inflammation and PVR development can be reduced with intravitreal dexamethasone at the end of the surgery. There is a need for studies involving a large number of patients to prove this.