ABSTRACT

Proliferative diabetic retinopathy, as the most complicated stage of diabetic eye disease almost always presents challenge for the surgeon. Despite prevention and current treatment approaches (anti-VEGF and laser photocoagulation) some of the cases progress to most advance stages of diabetic retinopathy which require surgical approach. Purpose of this study is to present the results of combined phaco-vitrectomy surgical procedure in patients with proliferative diabetic retinopathy, vitreal hemorrhage, epiretinal membranes and tractional retinal detachment. 31 patients were followed. Visual acuity ranges from L+P+ to 0,1. After complete ophthalmic examination which includes: visual acuity determination (Snellen charts), IOP measurement, optical coherence tomography – OCT, ultra sound – US examination and ophthalmoscopy, surgery was indicated. In order to reduce intra operative bleeding ant-VEGF injections (bevacizumab) were applied 3-5 days before the surgery in all patients. Combined 23G or 25G phaco-vitrectomy procedure was conducted in the same act. Implantation of hydrophobic intra ocular lens, posterior capsulotomy, membranectomy, peeling of ILM and laser photocoagulation were performed. 1300 cst Si oil or air was used as tamponade agent depending on the severity of retinopathy. 3 port or 4 port vitrectomy was used depending on extensiveness of retinal proliferations. In patients with extensive proliferations which were covering complete posterior pole, bimanual technique was used as the treatment of choice. Local therapy of tobramycin dexamethasone and NSAID was used for one month after the surgery. Follow up period was 18 months. Preoperative visual acuity before the surgery was L+P+ in 15 eyes while the mean visual acuity in the rest of 16 eyes was 0,05 (0,0083 – 0,1). In 13 eyes with preoperative visual acuity of L+P+ laser photocoagulation was not previously conducted. In 18 eyes extensive proliferations and tractional retinal detachment was found. Silicone oil was used in 17 eyes as tamponade agent and in 14 eye tamponade agent was air. Mean visual acuity after the surgery was 0,32 (0,033-0,6). In 3 eyes with preoperative visual acuity of L+P+ improvement in visual acuity was not achieved. Results of our study support the fact that surgery approach in most advance stages of proliferative diabetic retinopathy is the treatment of choice. Improvement in visual acuity was determined with the macula status before the surgery. The most complicated surgeries with extensive proliferations were in patients without prior treatment, either laser photocoagulation or anti-VEGF what supports the fact of its importance . Preoperative use of anti-VEGF significantly reduced intra-operative bleeding as well as postoperative bleeding in cases were it was injected at the end of the surgery. In a cases with broad adhesions and tractional retinal detachment bimanual technique is technique of choice. This technique allows the surgeon to find the plane of dissection easier, and by that reduces the iatrogenic damage and prevents the bleeding which can easily compromise the results of the surgery. Use of silicon oil in most severe cases was of great help in a way that allowed better visualisation of retina immediately after the surgery and allow some time for stabilisation. Visual acuity remained stable during follow up period and 8 eyes were additionally treated with anti-VEGF (bevacizumab) or triamcinolone.


CONTACT DETAILS

Vladislav Dzinic, A. Oros, M. Dzinic
Clinical center of Vojvodine, University Eye Clinic Novi Sad
Novi Sad
Serbia
Email : vdzinic@dzinic.rs
Cell Phone: +38163518863
Work Phone: +38121520961