http://www.evrs.eu/medias/2006/congress/25-Gauge-Vitrectomy-for-Advanced-Proliferative-Diabetic-Retinopathy:-A-Consecutive-Case-Series-Including-Complex-Retinal-Detachments.swf

Firas M. Rahhal, MD (Los Angeles, CA)*

PURPOSE:

The author hypothesizes that with recent advances in technology, instrumentation, and experience, 25g pars plana vitrectomy (PPV) is safe and effective for the treatment of both simple and complex cases of advanced PDR. The study evaluates the visual and anatomic outcomes in a consecutive series of eyes with complications of PDR exclusively treated with 25g surgery.

METHODS:

The study is a retrospective, consecutive case series of 79 eyes (at the time of submission) with advanced PDR requiring vitrectomy. All eyes were treated exclusively with 25g PPV techniques utilizing the Alcon Accurus 25g System, with the 1500cpm pneumatic handpiece. No eyes during the study period were “selected out” for 20g surgery. The study is single surgeon, single institution. Main outcome measures were pre-operative and post-operative visual acuity, preoperative and post-operative presence of RD, and reoperation rate. Secondary outcome measures included the development of neovascular glaucoma, cataract, and the clarity of the vitreous at the final visit.

RESULTS:

Pre-operative assessment revealed visual acuity (Va) to be: 1.3% 20/40 or better, 12.8% 20/50-20/200, 52.6% 20/300-CF, and 33.3% HM-LP. Pre-op RD was present in 37.2% of eyes. Mean follow-up was 4.5 months, with a range of 1-12 months. Post-op assessment revealed Va to be: 15.6% 20/40 or better, 57.1% 20/50- 20/200, 19.5% 20/300-CF, and 7.8% HM-LP. Post-op traction RD was present in 3.8%. Reoperation rate was 6.4% of eyes, including air-fluid exchanges performed in office. Vitreous chamber was clear at final visit in 97.4% of eyes. Neovascular glaucoma developed in 1.3% and cataract in 32.8% of eyes. No cases of endophthalmitis, wound leak, prolonged hypotony, or choroidal detachment were seen.

CONCLUSION:

25g PPV is a safe and highly effective technique for the treatment of advanced PDR, even when complex retinal detachments exist. This surgical approach can be essentially universally employed for the complications of PDR. The techniques will continue to evolve with greater experience and improved instrumentation, and appears to be an excellent surgical option for our patients.
* Financial interest disclosed