Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature.
Berrocal María H,Acaba-Berrocal Luis
Current opinion in ophthalmology
PURPOSE OF REVIEW:Diabetic retinopathy (DR) is one of the leading causes of preventable vision loss in the world and its prevalence continues to increase worldwide. One of the ultimate and visually impairing complications of DR is proliferative diabetic retinopathy (PDR) and subsequent tractional retinal detachment. Treatment modalities, surgical techniques, and a better understanding of the pathophysiology of DR and PDR continue to change the way we approach the disease. The goal of this review is to provide an update on recent treatment modalities and outcomes of proliferative diabetic retinopathy and its complications including tractional retinal detachment. RECENT FINDINGS:Panretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF), and pars plana vitrectomy are the mainstay of PDR treatment. However, PRP and anti-VEGF are associated with significant treatment burden and multiple subsequent treatments. Early vitrectomy is associated with vision preservation, less treatment burden, and less subsequent treatments than therapy with PRP and anti-VEGF. SUMMARY:Concerning costs, high rates of noncompliance in the diabetic population and significant rates of subsequent treatments with initial PRP and anti-VEGF, early vitrectomy for diabetic retinopathy in patients at risk of PDR is a cost-effective long-term stabilizing treatment for diabetics with advanced disease.
Retinal vessel oxygen saturation increases after vitrectomy.
Lim Laurence Shen,Tan Licia,Perera Shamira
Investigative ophthalmology & visual science
PURPOSE:To evaluate the effects of vitrectomy on retinal vascular oxygen saturation in an adult population. METHODS:This was a prospective observational study. Twenty-seven eyes of 27 patients who underwent vitrectomy for macular conditions were included. Retinal oximetry was performed using the Oxymap system prior to vitrectomy and 3 months after surgery and the mean retinal arterial and venous oxygen saturation were measured. The arterial-venous difference (AVD) was calculated as the difference between the arterial and venous saturations. Multivariate linear regression models were constructed to compare oxygen saturation before and after surgery, with adjustments for age, sex, hypertension, hyperlipidemia, diabetes mellitus, and indication for surgery. RESULTS:The mean age of the subjects was 68.4 ± 8.9 years, 15 (55%) were male and the majority were of Chinese ethnicity (93%). The mean arterial saturation increased significantly after vitrectomy (101.93 ± 8.36% vs. 96.16 ± 14.14%, P = 0.01). The mean venous saturation also increased significantly after surgery (59.76 ± 8.52% vs. 50.40 ± 11.72%, P = 0.02). The mean AVD significantly decreased from 45.76 ± 12.18% before surgery to 42.17 ± 10.94% after surgery (P = 0.02). CONCLUSIONS:Retinal arterial and venous oxygen saturation are significantly increased after vitrectomy, while the AVD is decreased after vitrectomy.