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TRActional DIabetic reTInal detachment surgery with co-adjuvant intravitreal dexamethasONe implant: the TRADITION STUDY

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Abstract

Aim

Main failure of diabetic tractional retinal detachment (TRD) surgery is the development of proliferative vitreoretinopathy (PVR), causing higher re-detachment rates. We investigated whether the use of dexamethasone (DEX) implant at the end of pars plana vitrectomy (PPV) with silicone oil tamponade might have an impact on these outcomes.

Design

Comparative, nonrandomized, retrospective study.

Participants

A total of 148 eyes from 148 patients that underwent PPV with silicone oil tamponade for diabetic TRD (with DEX implant, n = 52; without DEX implant, n = 96).

Methods

Consecutive patients’ records were reviewed for time between TRD diagnosis and surgery; lens status before surgery and after 6, 12, and 24 months; retina attachment rate after primary PPV; change in postoperative PVR severity; rate of re-detachment at 6, 12, and 24 months; use of IOP lowering treatment after 6, 12, and 24 months; surgery details; intra- and postoperative complications. Correlations between outcome measures, postoperative PVR severity, and re-detachment rates were analyzed.

Main outcome measures

Change in postoperative PVR severity and retinal re-detachment rates with and without the adjuvant use of DEX implant.

Results

Retinal re-detachment rates were significantly higher in the group of patients that did not receive DEX implant [11/96 (11.5%) vs. 0/52 (0%), p = 0.049; 11/84 (12.9%) vs. 4/52 (7.7%), p = 0.007; 14/71 (19.7%) vs. 5/52 (10%) p < 0.001 at 6, 12, and 24 months, respectively]. PVR severity correlated with retinal status at 12 and 24 months (p = 0.018 and p = 0.027, respectively). The difference in PVR severity between the two groups was statistically significant at 6, 12, and 24 months (p < 0.001).

Conclusions

DEX implant at the end of PPV in patients with diabetic TRD improves PVR severity and decreases re-detachment rates. This should be considered as an option in the customized treatment of TRD.

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Author information

Author notes

  1. Matias Iglicki and Dinah Zur have contributed equally to this work.

Authors and Affiliations

  1. Private Retina Service, University of Buenos Aires, 525 Aguirre St., 3rd Floor, Apt. A, 1414, Buenos Aires, Argentina

    Matias Iglicki & Rodrigo Santos

  2. Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Dinah Zur, Dua Masarwa, Shulamit Schwarz, Adiel Barak & Anat Loewenstein

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Dinah Zur, Dua Masarwa, Shulamit Schwarz, Adiel Barak & Anat Loewenstein

  4. Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia

    Adrian Fung

  5. Faculty of Medicine and Health Sciences, Macquarie University Hospital, Sydney, NSW, Australia

    Adrian Fung

  6. Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, NSW, Australia

    Adrian Fung

  7. Ophthalmology Department, DIJON University Hospital, Burgundy, France

    Pierre-Henry Gabrielle

  8. Eye Clinic, Department of Biomedical and Clinical Science, “Luigi Sacco”, Luigi Sacco Hospital, University of Milan, Milan, Italy

    Marco Lupidi

  9. Department of Ophthalmology, University of Leipzig, Leipzig, Germany

    Catharina Busch & Matus Rehak

  10. Ophthalmology Department Istanbul, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Zafer Cebeci

  11. Dr. Charles Ophthalmology Center, Buenos Aires, Argentina

    Martin Charles

  12. Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel

    Anat Loewenstein

Authors
  1. Matias Iglicki
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  2. Dinah Zur
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  3. Adrian Fung
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  6. Rodrigo Santos
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  7. Catharina Busch
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  10. Martin Charles
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for the International Retina Group (IRG)

Corresponding author

Correspondence to Matias Iglicki.

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Conflict of interest

None.

Ethical approval

The study was approved by the Tel Aviv Sourasky Medical Center Institutional Review Board (Helsinki Committee), nr. 0745-18-TLV.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Iglicki, M., Zur, D., Fung, A. et al. TRActional DIabetic reTInal detachment surgery with co-adjuvant intravitreal dexamethasONe implant: the TRADITION STUDY. Acta Diabetol 56, 1141–1147 (2019). https://doi.org/10.1007/s00592-019-01357-y

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  • DOI: https://doi.org/10.1007/s00592-019-01357-y

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