Twenty-three-gauge vitrectomy for diabetic tractional retinal detachment: outcomes and prognostic factors
Journal Tunisien d’Ophtalmologie, Volume 31, N°1, 2022
3 mars 2022Etude des métamorphopsies au cours des membranes épirétiniennes idiopathiques avant et après chirurgie
3 mars 2022
La vitrectomie 23 gauges pour le décollement rétinien tractionnel du diabétique : résultats et facteurs pronostiques.
Houda Lajmi*, Slim Jaraya, Bouazzeoui Ouafi, Racem Choura, Amin Zahaf, Wassim Hmaied.
Department of Ophthalmology, FSI Hospital, La Marsa, Tunisia
Faculy of Medicine, University of Tunis El Manar, Tunis, Tunisia.
Keywords
Diabetic retinopathy, Retinal detachment, Vitrectomy, Risk factors.
Abstract
Purpose. To assess the anatomical results, the functional results, and the complications of 23 gauges vitrectomy in diabetic tractional retinal detachment surgery (TRD). We aimed also to identify the factors influencing these results.
Methods. A retrospective study including 50 patients (50 eyes). All patients were operated by 23 gauges vitrectomy for diabetic TRD. Pre-operative status, surgical procedure as well as post-operative status, were recorded. We studied the anatomical and the functional outcomes as well as their predictive factors (demographic characteristics, diabetes balance, DRT characteristics, the surgical procedure, and pre- and post-operative complications).
Results. The best mean corrected visual acuity was 1.5LogMar ± 0.6 preoperatively. Cataract was present in 24% of cases, rubeosis was present in 10% of cases, neovascular glaucoma was present in 6% of cases, retinal breaks and vitreal hemorrhage were present in 4% and 40% of cases, respectively. The macula was detached in 76% of the cases. A 23G was performed in all cases with silicone oil tamponade. Intraoperative hemorrhage and iatrogenic breaks occurred both in 18% of cases. Functional and anatomical success rates were 80% and 90% respectively. A delay of silicone oil removal more than 6 months (p=0.001, OR=0.842) was a risk factor for functional failure, impaired renal function was a risk factor for anatomical failure (p=0.014, OR=18.724).
Conclusions. Twenty-three gauges vitrectomy was an effective means for the management of diabetic TRD. It ensured satisfactory rates of anatomical and functional success. Long-term post-operative follow-up is mandatory to depict any complications on time.