Vitrectomy for proliferative diabetic retinopathy with severe equatorial fibrovascular proliferation. Am J Ophthalmol 1995 May;119(5):563-70
Date
05/01/1995Pubmed ID
7733181DOI
10.1016/s0002-9394(14)70213-2Scopus ID
2-s2.0-0029043999 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
PURPOSE: We studied the surgical treatment and visual outcome in a consecutive series of eyes with an unusual syndrome of diabetic retinopathy and severe peripheral fibrovascular proliferation involving the equatorial and pre-equatorial fundus.
METHODS: In a retrospective study of 276 eyes (245 patients) that underwent pars plana vitrectomy for diabetic retinopathy between November 1988 and February 1993, nine eyes of eight patients (3.3% of eyes and 3.3% of patients) had severe equatorial fibrovascular proliferation. The condition occurred primarily in previously unoperated-on eyes (except for panretinal photocoagulation) and resulted in peripheral traction or traction-rhegmatogenous retinal detachment (six eyes), severe vitreous hemorrhage (two eyes), and severe hypotony (one eye). Relief of traction from peripheral fibrovascular membranes was obtained with an encircling scleral buckle (nine eyes) and limited delamination and segmentation (five eyes) or relaxing retinectomy (two eyes). Lensectomy was required for adequate membrane dissection in three eyes.
RESULTS: After follow-up of six to 52 months (mean, 20.4 months), the visual acuity was 20/200 or better in seven of nine eyes, with complete retinal attachment in seven of nine eyes and postequatorial attachment in all eyes (100%). Poor outcome resulted from a persistent response resembling Coats' disease in one eye and preexistent long-standing retinal detachment in one eye.
CONCLUSIONS: Vitrectomy for severe equatorial fibrovascular proliferation differs from conventional approaches to diabetic retinopathy in that relief of retinal traction must be attained by scleral buckling and adequate dissection of peripheral fibrovascular tissue. In advanced cases, lensectomy and relaxing retinotomy may be required.
Author List
Han DP, Pulido JS, Mieler WF, Johnson MWMESH terms used to index this publication - Major topics in bold
AdultDiabetic Retinopathy
Female
Fundus Oculi
Humans
Lens, Crystalline
Male
Middle Aged
Retinal Detachment
Retinal Neovascularization
Retrospective Studies
Scleral Buckling
Visual Acuity
Vitrectomy
Vitreous Hemorrhage