Öz
Objective: To evaluate the pars plana vitrectomy (PPV) surgery results of the patients with diabetic tractional retinal detachment (TRD).Methods: Two hundred ten eyes of 193 patients with diabetic TRD were enrolled to the study. Patients with TRD underwent 23-Gauge(G) PPV were reviewed retrospectively. All patients’ preoperative and postoperative visual acuity changes, intraocular pressure changes, biomicroscopy, indirect ophthalmoscopy fundus examination, intraoperative and postoperative complications, intraoperative use of tamponade and postoperative period surgical notes were evaluated.Results: Ninety-five males (49.2%), 98 female (50.8%) of 193 patients were included to the study. Mean age was 56.01 ± 10.91 years during the surgery. The average postoperative follow-up period was 18.47 ± 14.06 months. Ninety-seven eyes were performed preoperative intravitreal (IV) bevacizumab injection. Statistically significant increase in the final visual acuity compared to the controls were recorded at 1, 3, 6, 12, 24, 36. months. (p<0.001). Preoperative and postoperative 1st day, 1st month, 6th months, 12th months results were statistically significant according to intraocular pressure (p<0.001). While 201 (95%) cases achieved anatomical success, 165 (78.5%) cases were achieved functional success.Conclusion: PPV is very effective method in providing anatomical and functional outcomes in patients with diabetic TRD. Preoperative intravitreal bevacizumab application is an effective treatment method in reducing intraoperative and postoperative complications, and shorten the operation time. J Clin Exp Invest 2015; 6 (1): 27-32
Anahtar Kelimeler
Tractional retinal detachment pars plana vitrectomy diabetic retinopathy
Kaynakça
- Kakehashi A: Total en bloc excision:A modified vicrectomy
- technigue for proliferative diabetic retinopathy.
- Am J Ophtalmol 2002;134:763-765.
- Wild S, Roglic G, Green A, et al. Global prevalence of
- diabetes: estimates for the year 2000 and projections
- for 2030. Diabetes Care 2004;27:1047–1053.
- Fine SL, Patz A. Ten years after the Diabetic Retinopathy
- Study. Ophthalmology 1987;94:739–740.
- Meredith T.A, Kaplan H.J, Aaberg T.M. Pars plana
- vitrectomy techniques for relief of epiretinal traction by membrane segmentation.Am J Ophtalmol
- ;89:408-413.
- Brourman ND, Blumenkranz MS, Cox MS, Trese MT.
- Silicone oil for the treatment of severe proliferative diabetic
- retinopathy. Ophthalmology 1989;96:759-764.
- Flynn Jr HW, Chew EY, Simons BD, et al. Pars plana
- vitrectomy in the Early Treatment Diabetic Retinopathy
- Study ETDRS report number 17. Ophthalmology
- ;99:1351–1357.
- Williams DF, Williams GA, Hartz A, et al. Results of
- vitrectomy for diabetic traction retinal detachments
- using the en bloc excision technique. Ophthalmology
- ;96:752–758.
- Hernandez-Da Mota SE, Nunez-Solorio SM. Experience
- with intravitreal bevacizumab as a preoperative
- adjunct in 23-G vitrectomy for advanced proliferative
- diabetic retinopathy. Eur J Ophthalmol 2010;20:1047–
- -
- Aaberg T.M, Abrams G.W. Changing indications and
- techniques for vitrectomy in management of complications
- of diabetic retinopathy. Ophthalmology
- ;94:775-779.
- Ratner CM, Michels RG, Auer C, Rice TA. Pars plana
- vitrectomy for complicated retinal detachments. Ophthalmology.
- ;90:1323-1327.
- Meier P, Wiedemann P. Vitrectomy for tractional macular
- detachment in diabetic retinopathy. Graefes Arch
- Clin Exp Ophthalmol 1997;235:569-574.
- Kır N. Diabetik retinopatide pars plana vitrektomi
- sonuçları. T Oft Gaz 2001;31:638-643.
- Kangas TA, Bennett SR, Flynn HW Jr, et al. Reversible
- loss of light perception after vitreoretinal surgery.
- Am J Ophthalmol 1995;120:751-756.
- Blankenship G, Cortez R, Machemer R. The lens and
- pars plana vitrectomy for diabetic retinopathy complications.
- Arch Ophthalmol 1979;97:1263-1267.
- Rice TA, Michels RG, Maguire MG, Rice EF. The effect
- of lensectomy on the incidence of iris neovascularization
- and neovascular glaucoma after vitrectomy
- for diabetic retinopathy. Am J Ophthalmol 1983;95:1-
- -
- Braunstein RE, Airiani S. Cataract surgery results
- after pars plana vitrectomy. Curr Opin Ophthalmol
- ;14:150-154.
- Biro Z, Kovacs B. Results of cataract surgery in previously
- vitrectomized eyes. J Cataract Refract Surg
- ;28:1003-1006.
- Michels RG. Vitreous surgery for macular pucker. Am
- J Ophthalmol 1981;92:628-369.
- Williams DF, Williams GA, Hartz A, et al. Results of
- vitrectomy for diabetic traction retinal detachments
- using the en bloc excision technique. Ophthalmology
- ;96:752-758.
- La Heij EC, Tecim S, Kessels AG, et al. Clinical variables
- and their relation to visual outcome after vitrectomy
- in eyes with diabetic retinal traction detachment.
- Graefes Arch Clin Exp Ophthalmol 2004;242:210-217.
- Schachat AP, Oyakawa RT, Michels RG, Rice T.A.
- Complications of vitreous surgery for diabetic retinopathy.
- II. Postoperative complications. Ophthalmology
- ;90:522-530.
Diyabetik traksiyonel retina dekolmanlı olgularda 23-gauge pars plana vitrektomi cerrahisi sonuçları
Öz
Amaç: Diyabetik traksiyonel retina dekolman (TRD)’lı hastalara uygulanan pars plana vitrektomi (PPV) sonuçlarını ve komplikasyonlarını incelemek. Yöntemler: Diyabetik TRD’si bulunan 193 hastanın 210 gözü çalışmaya dahil edildi. TRD nedeniyle 23-Gauge (G) PPV yapılan hastalarımızın dosyaları geriye dönük olarak incelendi. Tüm hastaların preoperatif ve postoperatif görme keskinliği (GK), göz-içi basınç (GİB)’ları, biyomikroskopik muayeneleri, indirekt oftalmoskopla fundus muayeneleri, intraoperatif ve postoperatif komplikasyonları, intraoperatif endotamponad kullanımı, postoperatif dönemde geçirdikleri ameliyatlar kaydedildi. Bulgular: Çalışmaya alınan 193 hastanın 95’i erkek (%49,2), 98’i kadın (%50,8) olup cerrahi sırasındaki yaş ortalamaları 56,01 ±10,91 yıl idi. Hasta grubumuzun ortalama postoperatif takip süresi 18,47 ±14,06 (3-54) ay idi. 97 göze preoperatif intravitreal (İV) bevacizumab enjeksiyonu yapıldı. Hastaların preoperatif GK’leri ile postoperatif 1.,3.,6,12.,24.,36. ay ve son kontrollerdeki GK’leri karşılaştırıldığında istatistiksel olarak anlamlı bir artış görüldü (p≤0.001). Preoperatif GİB’ları ile postoperatif 1. gün, 1. ay, 6. ay, 12. ay ve hastaların en son takiplerindeki GİB’leri arasında istatistiksel olarak anlamlı fark görüldü (p < 0.001). Preoperatif İV bevacizumab enjeksiyonu uygulanan hastalarla uygulanmayan hastalar arasında postoperatif proliferatif diyabetik retinopati komplikasyonları, intraoperatif hemoraji ve iyatrojenik retina yırtığı gelişmesi açısından istatistiksel olarak anlamlı fark tespit edildi. Vakaların 201 (%95)’inde anatomik başarı, 165 (%78,5)’inde fonksiyonel başarı sağlandı. Sonuç: PPV diyabetik TRD’li hastalarda anatomik ve fonksiyonel başarı sağlamak açısından oldukça etkili bir cerrahidir. Preoperatif İV bevacizumab uygulaması da intraoperatif ve postoperatif komplikasyonları azaltarak ameliyat süresini kısaltmada faydalı bir tedavi yöntemi olarak görülmektedir.
Anahtar Kelimeler
Traksiyonel retina dekolmanı pars plana vitrektomi diyabetik retinopati
Kaynakça
- Kakehashi A: Total en bloc excision:A modified vicrectomy
- technigue for proliferative diabetic retinopathy.
- Am J Ophtalmol 2002;134:763-765.
- Wild S, Roglic G, Green A, et al. Global prevalence of
- diabetes: estimates for the year 2000 and projections
- for 2030. Diabetes Care 2004;27:1047–1053.
- Fine SL, Patz A. Ten years after the Diabetic Retinopathy
- Study. Ophthalmology 1987;94:739–740.
- Meredith T.A, Kaplan H.J, Aaberg T.M. Pars plana
- vitrectomy techniques for relief of epiretinal traction by membrane segmentation.Am J Ophtalmol
- ;89:408-413.
- Brourman ND, Blumenkranz MS, Cox MS, Trese MT.
- Silicone oil for the treatment of severe proliferative diabetic
- retinopathy. Ophthalmology 1989;96:759-764.
- Flynn Jr HW, Chew EY, Simons BD, et al. Pars plana
- vitrectomy in the Early Treatment Diabetic Retinopathy
- Study ETDRS report number 17. Ophthalmology
- ;99:1351–1357.
- Williams DF, Williams GA, Hartz A, et al. Results of
- vitrectomy for diabetic traction retinal detachments
- using the en bloc excision technique. Ophthalmology
- ;96:752–758.
- Hernandez-Da Mota SE, Nunez-Solorio SM. Experience
- with intravitreal bevacizumab as a preoperative
- adjunct in 23-G vitrectomy for advanced proliferative
- diabetic retinopathy. Eur J Ophthalmol 2010;20:1047–
- -
- Aaberg T.M, Abrams G.W. Changing indications and
- techniques for vitrectomy in management of complications
- of diabetic retinopathy. Ophthalmology
- ;94:775-779.
- Ratner CM, Michels RG, Auer C, Rice TA. Pars plana
- vitrectomy for complicated retinal detachments. Ophthalmology.
- ;90:1323-1327.
- Meier P, Wiedemann P. Vitrectomy for tractional macular
- detachment in diabetic retinopathy. Graefes Arch
- Clin Exp Ophthalmol 1997;235:569-574.
- Kır N. Diabetik retinopatide pars plana vitrektomi
- sonuçları. T Oft Gaz 2001;31:638-643.
- Kangas TA, Bennett SR, Flynn HW Jr, et al. Reversible
- loss of light perception after vitreoretinal surgery.
- Am J Ophthalmol 1995;120:751-756.
- Blankenship G, Cortez R, Machemer R. The lens and
- pars plana vitrectomy for diabetic retinopathy complications.
- Arch Ophthalmol 1979;97:1263-1267.
- Rice TA, Michels RG, Maguire MG, Rice EF. The effect
- of lensectomy on the incidence of iris neovascularization
- and neovascular glaucoma after vitrectomy
- for diabetic retinopathy. Am J Ophthalmol 1983;95:1-
- -
- Braunstein RE, Airiani S. Cataract surgery results
- after pars plana vitrectomy. Curr Opin Ophthalmol
- ;14:150-154.
- Biro Z, Kovacs B. Results of cataract surgery in previously
- vitrectomized eyes. J Cataract Refract Surg
- ;28:1003-1006.
- Michels RG. Vitreous surgery for macular pucker. Am
- J Ophthalmol 1981;92:628-369.
- Williams DF, Williams GA, Hartz A, et al. Results of
- vitrectomy for diabetic traction retinal detachments
- using the en bloc excision technique. Ophthalmology
- ;96:752-758.
- La Heij EC, Tecim S, Kessels AG, et al. Clinical variables
- and their relation to visual outcome after vitrectomy
- in eyes with diabetic retinal traction detachment.
- Graefes Arch Clin Exp Ophthalmol 2004;242:210-217.
- Schachat AP, Oyakawa RT, Michels RG, Rice T.A.
- Complications of vitreous surgery for diabetic retinopathy.
- II. Postoperative complications. Ophthalmology
- ;90:522-530.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Araştırma Yazısı |
| Yazarlar | |
| Yayımlanma Tarihi | 10 Mayıs 2015 |
| Yayımlandığı Sayı | Yıl 2015 |