Skip to main content

Advertisement

SpringerLink
Log in

Safety and effectiveness of pre-emptive diabetic vitrectomy in patients with severe, non-fibrotic retinal neovascularisation despite panretinal photocoagulation

  • Article
  • Published:
Eye Submit manuscript

Abstract

Objectives

To investigate the safety and effectiveness of pre-emptive vitrectomy in eyes with severe non-fibrotic proliferative diabetic retinopathy.

Methods

A multi-centre, retrospective, observational study. Pre-emptive vitrectomy was performed in non-fibrotic diabetic eyes with a visual acuity (VA) of 20/50 or better, where there was extensive persistent neovascularisation despite prior panretinal photocoagulation, and where the fellow eye had established sight loss despite vitrectomy for tractional complications. The primary outcome measure was the VA at last visit.

Results

Twenty patients were included. The mean age was 39 ± 14 years. Fifteen patients were Type 1 diabetic. The median baseline VA was 20/30 and remained stable at 20/28 at last visit (median follow-up period: 24 months). Eight eyes (40.0%) developed post-operative vitreous cavity haemorrhage; 4 of which required a vitreous cavity washout procedure. There were no post-operative retinal detachments. The index eye remained the significantly better eye at all time points bar one month post-surgery. Regression of retinopathy grading was observed in all eyes.

Conclusion

In this pilot study, we found no sight loss with pre-emptive diabetic vitrectomy. Better eye status was maintained in this high-risk group. Further study with larger number of patients and longer-term follow-up is indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2: Pre- and post- operative colour fundal photographs.

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Resnikoff S, Pascolini D, Etya’ale D, Kocur I, Pararajasegaram R, Pokharel GP, et al. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82:844–51.

    PubMed  PubMed Central  Google Scholar 

  2. Gross JG, Glassman AR, Jampol LM, Inusah S, Aiello LP, Antoszyk AN, et al. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA 2015;314:2137–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Gross JG, Glassman AR, Liu D, Sun JK, Antoszyk AN, Baker CW, et al. Five-year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA Ophthalmol. 2018;136:1138–48.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Parikh R, Shah RJ, VanHouten JP, Cherney EF. Ocular findings at initial pan-retinal photocoagulation for proliferative diabetic retinopathy predict the need for future pars plana vitrectomy. Retina 2014;34:1997–2002.

    Article  CAS  PubMed  Google Scholar 

  5. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial–Diabetic Retinopathy Vitrectomy Study Report 3. The Diabetic Retinopathy Vitrectomy Study Research Group. Ophthalmology. 1988;95:1307–20.

  6. Khan MA, Samara WA, Hsu J, Garg S. Short-term outcomes of hybrid 23-, 25-, and 27-gauge vitrectomy for complex diabetic tractional retinal detachment repair. Retin Cases Brief Rep. 2019;13:244–7.

    Article  PubMed  Google Scholar 

  7. Ozone D, Hirano Y, Ueda J, Yasukawa T, Yoshida M, Ogura Y. Outcomes and complications of 25-gauge transconjunctival sutureless vitrectomy for proliferative diabetic retinopathy. Ophthalmologica 2011;226:76–80.

    Article  PubMed  Google Scholar 

  8. Jackson TL, Johnston RL, Donachie PH, Williamson TH, Sparrow JM, Steel DH. The Royal College of Ophthalmologists’ National Ophthalmology Database Study of Vitreoretinal Surgery: Report 6, Diabetic Vitrectomy. JAMA Ophthalmol. 2016;134:79–85. quiz 120

    Article  PubMed  Google Scholar 

  9. Shea M. Early vitrectomy in proliferative diabetic retinopathy. Arch Ophthalmol. 1983;101:1204–5.

    Article  CAS  PubMed  Google Scholar 

  10. Hwang JC, Sharma AG, Eliott D. Fellow eye vitrectomy for proliferative diabetic retinopathy in an inner city population. Br J Ophthalmol. 2013;97:297–301.

    Article  PubMed  Google Scholar 

  11. Sulak M, Urbancic M, Petrovic MG. Predicting visual outcomes of second eye vitrectomy for proliferative diabetic retinopathy. Retina 2018;38:698–707.

    Article  PubMed  Google Scholar 

  12. JT H. Visual acuity measurements. J Cataract Refractive Surg. 2004;30:287–90.

    Article  Google Scholar 

  13. Schreur V, Brouwers J, Van Huet RAC, Smeets S, Phan M, Hoyng CB, et al. Long-term outcomes of vitrectomy for proliferative diabetic retinopathy. Acta Ophthalmol. 2021;99:83–9.

    Article  PubMed  Google Scholar 

  14. Kohner EM, Hamilton AM, Joplin GF, Fraser TR. Florid diabetic retinopathy and its response to treatment by photocoagulation or pituitary ablation. Diabetes 1976;25:104–10.

    Article  CAS  PubMed  Google Scholar 

  15. Beaumont P, Hollows FC. Classification of diabetic retinopathy, with therapeutic implications. Lancet 1972;1:419–25.

    Article  CAS  PubMed  Google Scholar 

  16. Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study (DRVS) report #1. Ophthalmology. 1985;92:492–502.

  17. Sokol JT, Schechet SA, Rosen DT, Ferenchak K, Dawood S, Skondra D. Outcomes of vitrectomy for diabetic tractional retinal detachment in Chicago’s county health system. PLoS One. 2019;14:e0220726.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Mikhail M, Ali-Ridha A, Chorfi S, Kapusta MA. Long-term outcomes of sutureless 25-G+ pars-plana vitrectomy for the management of diabetic tractional retinal detachment. Graefes Arch Clin Exp Ophthalmol. 2017;255:255–61.

    Article  PubMed  Google Scholar 

  19. Pichi F, Hay S, Abboud EB. Inner retinal toxicity due to silicone oil: a case series and review of the literature. Int Ophthalmol. 2020;40:2413–22.

    Article  PubMed  Google Scholar 

  20. Gupta B, Sivaprasad S, Wong R, Laidlaw A, Jackson TL, McHugh D, et al. Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study. Eye. 2012;26:510–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Smith JM, Steel DH, Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2015:CD008214.

  22. Yang CM. Surgical treatment for diabetic retinopathy: 5-year experience. J Formos Med Assoc. 1998;97:477–84.

    CAS  PubMed  Google Scholar 

  23. Khuthaila MK, Hsu J, Chiang A, DeCroos FC, Milder EA, Setlur V, et al. Postoperative vitreous hemorrhage after diabetic 23-gauge pars plana vitrectomy. Am J Ophthalmol. 2013;155:757–63. 63.e1-2

    Article  PubMed  Google Scholar 

  24. Tan SZ, Dellʼ Aversana Orabona G, Robins JJ, Kumaran N, Wong R. “Delamination Plus”: A Technique to Reduce Immediate Postoperative Diabetic Cavity Hemorrhage. Retina. 2020. Online ahead of print.

  25. Torres-Soriano ME, Reyna-Castelán E, Hernández-Rojas M, García-Aguirre G, Kon-Jara V, Diaz-Rubio JL, et al. Tractional retinal detachment after intravitreal injection of bevacizumab in proliferative diabetic retinopathy. Retin Cases Brief Rep. 2009;3:70–3.

    Article  PubMed  Google Scholar 

  26. Oshima Y, Shima C, Wakabayashi T, Kusaka S, Shiraga F, Ohji M, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology 2009;116:927–38.

    Article  PubMed  Google Scholar 

  27. Arevalo JF, Sanchez JG, Lasave AF, Wu L, Maia M, Bonafonte S, et al. Intravitreal Bevacizumab (Avastin) for Diabetic Retinopathy: The 2010 GLADAOF Lecture. J Ophthalmol. 2011;2011:584238.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The authors received no funding for the study.

Author information

Authors and Affiliations

  1. St Paul’s Eye Unit, Liverpool University Hospitals, Liverpool, UK

    Shi Zhuan Tan

  2. Sunderland Eye Infirmary, Sunderland, UK

    David H. Steel

  3. Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK

    David H. Steel

  4. Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach, Germany

    Boris V. Stanzel, Martin Bedersdorfer & Peter Szurman

  5. Tennent Institute of Ophthalmology, Great Western Road, Glasgow, UK

    Shohista Saidkasimova

  6. Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark

    Katja Christina Schielke

  7. Department of Ophthalmology, St Thomas’ Hospital, London, UK

    Neruban Kumaran & David Alistair H. Laidlaw

Authors
  1. Shi Zhuan Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David H. Steel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Boris V. Stanzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Bedersdorfer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Szurman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shohista Saidkasimova
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katja Christina Schielke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Neruban Kumaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David Alistair H. Laidlaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors meet the following criteria:1. Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results. 2. Drafted or revised the manuscript. 3. Approved the final version. 4. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Shi Zhuan Tan.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, S.Z., Steel, D.H., Stanzel, B.V. et al. Safety and effectiveness of pre-emptive diabetic vitrectomy in patients with severe, non-fibrotic retinal neovascularisation despite panretinal photocoagulation. Eye 37, 1553–1557 (2023). https://doi.org/10.1038/s41433-022-02167-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-022-02167-3

  • Springer Nature Limited

Search

Navigation