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International Ophthalmology

Published in:

01-05-2021 | Vitrectomy | Original Paper

Trimanual vitrectomy for severe proliferative diabetic retinopathy

Authors: Samir Mohammed El-Baha, Islam S. H. Ahmed

Published in: International Ophthalmology | Issue 5/2021

Abstract

Purpose

To describe and evaluate a novel technique of pars plana vitrectomy (PPV) under chandelier illumination which is aided with the vital dyes and perfluorocarbon liquids for the management of the complex diabetic vitrectomy cases.

Methods

We conducted a prospective interventional comparative study on 40 eyes of 36 patients with advanced diabetic eye disease requiring PPV. The study was conducted in a single tertiary referral center. Eyes were divided on 1:1 basis by stratified randomization into two groups. Group 1 had trimanual vitrectomy done assisted with chandelier illumination, perfluorocarbon liquid (PFCL) and vital dyes. Group 2 had the conventional bimanual vitrectomy done assisted with chandelier illumination only. All patients were followed up for a minimum of 6 months after the surgery.

Results

Forty eyes of 36 patients with the mean age of 51.42 years (range 28–69) were evaluated. The anatomical success at 6 months could be achieved in all the eyes in both groups. The complete removal of the pre-retinal proliferations could be accomplished in all the eyes in the trimanual PPV group, and only in 85% of the eyes in the bimanual PPV group. Operative time was significantly shorter in the trimanual PPV group (p < 0.001). More eyes in the trimanual PPV group (55.0%) could achieve better vision (> 6/60) 6 months after the operation compared to the bimanual PPV group (50.0%), but this difference was not statistically significant.

Conclusion

Trimanual PPV is a novel, safe and effective technique that can improve the results of the complex diabetic PPV.

Aaberg TM (1981) Pars plana vitrectomy for diabetic traction retinal detachment. Ophthalmology 88(7):639–642CrossRef

Eckardt C (2003) Twin lights: a new chandelier illumination for bimanual surgery. Retina 23(6):893–894CrossRef

Oshima Y, Shima C, Wakabayashi T et al (2009) Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology 116(5):927–938CrossRef

Horiguchi M, Kojima Y, Shimada Y (2002) New system for fiberoptic-free bimanual vitreous surgery. Arch Ophthalmol 120(4):491–494CrossRef

Fujii GY, De Juan Jr E, MS, Humayun et al (2002) A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology 109(10):1807–1812CrossRef

Eckardt C (2005) Transconjunctival sutureless 23-gauge vitrectomy. Retina 25(2):208–211CrossRef

Murthy RK, Chalam KV (2010) Assistant-independent OptiFlex system for contact and noncontact wide-angle viewing in vitreoretinal surgery. Arch Ophthalmol 128(4):490–492CrossRef

Veckeneer M, Mohr A, Alharthi E et al (2014) Novel ‘heavy’ dyes for retinal membrane staining during macular surgery: multicenter clinical assessment. Acta Ophthalmol 92(4):339–344CrossRef

Chang S (1987) Low viscosity liquid fluorochemical in vitreous surgery. Am J Ophthalmol 103:38–43CrossRef

10.

Chang S, Lincoff H, Zimmerman NJ et al (1989) Giant retinal tears: surgical techniques and results using perfluorocarbon liquid. Arch Ophthalmol 107:761–766CrossRef

11.

Chang S, Ozmert E, Zimmerman NJ (1988) Intraoperative perfluorocarbon liquid in the management of proliferative retinopathy. Am J Ophthalmol 106:668–674CrossRef

12.

Chang S, Reppucci V, Zimmerman NJ (1989) Perfluorocarbon liquid in the management of traumatic retinal detachment. Ophthalmology 96:785–792CrossRef

13.

Glaser AM, Carter J, Kuppermann BD (1991) Perfluoro-n-octane in the treatment of giant retinal tears with proliferative vitreoretinopathy. Ophthalmology 98:1613–1621CrossRef

14.

Lee KL, Alturki WA, Peyman GA et al (1992) Management of retinal detachment associated with choroidal coloboma using perfluoroperhydrophenanthrene (Vitreon). Ophthalmic Surg 23:553–554PubMed

15.

Movshovich A, Berrocal M, Chang S (1994) The protective properties of liquid perfluorocarbons in phacofragmentation of dislocated lenses. Retina (Philadelphia, Pa). 14(5):457–62CrossRef

16.

Shapiro MJ, Resnick KI, Kim SH et al (1991) Management of dislocated crystallin lens with a perfluorocarbon liquid. Am J Ophthalmol 112:401–405CrossRef

17.

Rowson NJ, Bascon AS, Rosen PH (1992) Perfluorocarbon heavy liquids in the management of posterior dislocation of the lens nucleus during phacoemulsification. Br J Ophthalmol 76:169–170CrossRef

18.

Fanous MM, Friedman SM (1992) Ciliary sulcus fixation of a dislocated posterior chamber intraocular lens using liquid perfluorophenanthrene. Ophthalmic Surg 23:551–552PubMed

19.

Kamei M, Tano Y, Maeno T et al (1996) Surgical removal of submacular hemorrhage using tissue plasminogen activator and perfluorocarbon liquid. Am J Ophthalmol 121:267–275CrossRef

20.

Desai UR, Peyman GA, Chen CJ et al (1992) Use of perfluorophenanthrene in the management of suprachoroidal hemorrhage. Ophthalmology 99:1542–1547CrossRef

21.

Imamura Y, Minami M, Ueki M et al (2003) Use of perfluorocarbon liquid during vitrectomy for severe proliferative diabetic retinopathy. Br J Ophthalmol 87(5):563–566CrossRef

22.

Itoh R, Ikeda T, Sawa H et al (1999) The use of perfluorocarbon liquids in diabetic vitrectomy. Ophthalmic Surg Lasers 30:672–675CrossRef

23.

Maturi RK, Merrill PT, Lomeo MD et al (1999) Perfluoro-N-octane (PFO) in the repair of complicated retinal detachment due to severe proliferative diabetic retinopathy. Ophthalmic Surg Lasers 30:715–720CrossRef

24.

İlker S, Wafapoor H, Kertes PJ, Navarro GC et al (1998) The adjunctive use of perfluoroperhydrophenanthrene (Vitreon) in diabetic vitrectomy. Int ophthalmol 22(2):89–96CrossRef

25.

Bourke RD, Simpson RN, Cooling RJ et al (1996) The stability of perfluoro-n-octane during vitreoretinal procedures. Arch Ophthalmol 114:537–544CrossRef

26.

Moon H, Lee DY, Nam DH (2015) Trimanual technique using assistant-controlled light probe illumination and wide-angle viewing system in 23-gauge sutureless vitrectomy for diabetic tractional retinal detachment. Ophthalmic Surg, Lasers and Imaging Retina 46(1):73–76CrossRef

27.

Zinn KM, Grinblat A, Katzin HM et al (1980) A new endoillumination infusion for pars plana vitrectomy. Ophthalmic Surg 11:850–855PubMed

28.

Horiguchi M, Kojima Y, Shimada Y (2002) New system for fiberoptic-free bimanual vitreous surgery. Arch Ophthalmol 120:491–494CrossRef

29.

Steinmetz RL, Grizzard WS, Hammer ME (2002) Vitrectomy for diabetic traction retinal detachment using the multiport illumination system. Ophthalmology 109:2303–2307CrossRef

30.

Shen LJ, Wang ZY, Qu J, Wang QM (2009) Bimanual technique in proliferative diabetic retinopathy using an optical fiber-free intravitreal surgery system: a case control study. Eur J Ophthalmol 19(2):273–279CrossRef

31.

Wang ZY, Zhang Q, Zhao DS, Zhao PQ (2011) Four-port bimanual vitrectomy in fibrovascular membrane removal. Retina 31(4):798–800CrossRef

32.

Wang ZY, Zhao KK, Zhao DS, Zhao PQ (2012) Dissection under perfluorocarbon liquid: a modified vitrectomy technique for diabetic tractional retinal detachment. Retina 32(4):848–52CrossRef

Title: Trimanual vitrectomy for severe proliferative diabetic retinopathy
Authors: Samir Mohammed El-Baha
Islam S. H. Ahmed
Publication date: 01-05-2021
Publisher: Springer Netherlands
Keyword: Vitrectomy
Published in: International Ophthalmology / Issue 5/2021
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-021-01730-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Trimanual vitrectomy for severe proliferative diabetic retinopathy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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