http://www.evrs.eu/medias/2006/congress/Reoperation-after-Diabetic-Vitrectomy:-Rate,-Indications,-Visual-Outcomes,-and-Complications-in-an-Urban-Academic-Medical-Center.swf

Julie L. Gasperini, MD (Detroit, MI), Dean Eliott, MD (Los Angeles, CA)

PURPOSE:

To identify the rate, indications, visual outcomes, and complications in patients requiring reoperation(s) for the sequelae of proliferative diabetic retinopathy.

METHODS:

Retrospective chart review of 520 consecutive diabetic vitrectomies done by one vitreoretinal surgeon at the Kresge Eye Institute. The data collected included demographics, preoperative diagnosis, indications and surgical procedure(s), preoperative and final visual outcome, and complications.

RESULTS:

Of the 520 cases, 447 eyes underwent primary vitrectomy. Indications included TRD/RRD (23%), TRD involving the macula (21%), VH with extramacular TRD (32%), VH only (22%), and other (2%). Of the 447 eyes, 57 eyes (12.8%) required reoperation (44 eyes,1 reoperation; 10 eyes, 2 reoperations; 3 eyes, 3 reoperations). Indications included
ERM/fibrous proliferation with RRD (35%), ERM with macular traction (15%), ERM (2%), VH (36%), and NVG (11%). Mean followup was 2.4 yrs. In eyes requiring reoperation, final visual outcome was maintained or improved in 32% and decreased in 67% (NLP in 14 eyes). Final anatomic outcome included total retinal attachment (69%), peripheral RD with attached macula (6%), total RD (10%), phthisis (13%), and enucleation (2%). NVI developed in 22%, and NVI with NVG developed in 30% of eyes requiring reoperation. All patients with an unfavorable anatomic outcome (total RD, phthisis, enucleation), and all patients with NLP vision had NVI or NVG.

CONCLUSION:

Many of the primary vitrectomies were complex cases with TRD/RRD or TRD involving the macula. 12.8% of eyes required reoperation, most commonly because of ERM/traction or ERM/RRD. All patients who developed an unfavorable anatomic or visual outcome had NVI or NVG indicating severe ischemia.