Summary and Conclusion
Diabetes mellitus is the most common endocrinal diseases through out the world diabetes retinopathy is one of the leading causes of blindness in developed and underdeveloped countries.
The introduction of laser photocoagulation and pars plana vitrectomy has altered the natural course of diabetic retinopathy significantly, however the complications of proliferative diabetic retinopathy continue to be a major visual threat.
Pars plana vitrectomy is the standard management for complications of proliferative diabetic retinopathy, e.g. unresolved vitreous hemorrhage, traction retinal detachment and traction rhegmatogenous retinal detachment.
The advances in pars plana vitrectomy surgery are dramatic. In 2001, a new 25-gauge transconjunctival sutureless vitrectomy system was designed.
In this study, conventional vitrectomy was done for 22 eyes with traction retinal detachment and traction rhegmatogenous retinal detachment, while 25 gauge sutureless vitrectomy was done for 28 eyes with non clearing vitreous hemorrhage.
In this study, 40 % of eyes had preoperative best corrected visual acuity of 5/200 or better, while 60 % of eyes had best corrected visual acuity worse than 5/200. A postoperative best corrected visual acuity 5/200 or better was achieved in 88 % of eyes with 20/200 or better in 66% of eyes and 20/40 or better in 22 % of eyes. The mean preoperative best corrected visual acuity was 0.032 0.025, while the mean postoperative best corrected visual acuity was 0.239 0.186, hence the improvement in visual acuity was statistically significant.
Several difficulties and application occurred intraoperatively namely intraoperative hemorrhage and break formation. Postoperative complications were in the form of recurrent hemorrhage, recurrent proliferation traction and neovascular glaucoma.
We have not encountered any specific complications related to the use of 25-gauge sutureless vitrectomy.
Conclusion:
From this study and previous studies we conclude that the visual outcome of pars plana vitrectomy for complications of proliferative diabetic retinopathy depends mainly on the anatomic complexity of the eye.
The new 25-gauge transcojunctival sutureless vitrectomy system seems to be safe for the treatment of non-clearing vitreous hemorrhage, however, further improvement in the instrumentations to be rigid enough to deal with membranes is essential to widen the indications of transconjunctival sutureless vitrectomy system. |
