Author: houda lajmi (Tunisia)
Co-authors: Amin Zahaf, Besma Ben Achour
The aim of the study was to assess the anatomical and functional results, the complications of 23 gauges vitrectomy in surgery in diabetic tractional retinal detachment (TRD) as well as to identifying the factors influencing these results.
Ophthalmology service, FSI Hospital, La Marsa, Tunis, Tunisia
We conducted a retrospective study of 50 patients (50 eyes), between January 2013 and August 2020. All these patients were operated by 23 G vitrectomy for diabetic TRD. We included patients with TRDrequiring 23 gauges vitrectomy. Non-diabetic or recurrent TRD were excluded. Preoperative state, surgical procedure as well as post-operative state, were recorded. We studied the anatomical and the functional success in every patient as well as their predictive factors (such as demographic characteristics, diabetes balance, TRD description, the surgical procedure and pre and post-operative complications).
The mean age was 59 ± 8 years. Preoperatively, the best mean corrected visual acuity (BCVA) was 1.5LogMar ± 0.6. Cataract was present in 24% of cases, Iris rubeosis was present in 10% of cases, new vascular glaucoma (NVG) was present in 6% of cases, retinal tears and vitreal hemorrhage (VH) were present, respectively in 4% and 40% of cases. The TRD was extended over two quadrants in 44% of the cases and the macula was detached in 76% of the cases. Preoperative retinal photocoagulation was incomplete in 74% of cases. A 23G was performed in all cases with silicone oil tamponade. Associated phacoemulsification was performed in 34% of cases. Intraoperative hemorrhage and iatrogenic tears occurred both in 18% of cases. Postoperatively, the mean BCVA was 1 LogMAR ± 0.65. Silicone oil removal was performed in 72% of cases. Functional and anatomical success rates were 80% and 90% respectively. Silicon oil induced glaucoma occurred in 75% of complication cases. According to the multivariate study, a delay of silicone oil removal greater than 6 months (p = 0.001 and OR = 0.842) was a risk factor for functional failure, impaired renal function was a risk factor for anatomical failure (p = 0.014 and OR = 18.724)
Twenty-three-gauges vitrectomy was an effective means for the management of diabetic TRD. It ensured satisfactory rates of anatomical and functional success. However, careful, and long-term post-operative follow-up is mandatory to depict any complications on time.
no financial disclosure