Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy

Yumi Kamura,1 Yukihiro Sato,2 Yuzou Deguchi,3 Fumihiko Yagi31Department of Ophthalmology, Division of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan; 2Department of Diabetes Center, Jichi Medical University, Tochigi, Japan; 3Department of Ophthalmology, Toho University Sakura Med...

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Autores principales:	Kamura Y, Sato Y, Deguchi Y, Yagi F
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/60d7c8055e374631880e9018548bd761
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spelling	oai:doaj.org-article:60d7c8055e374631880e9018548bd7612021-12-02T04:32:01ZIatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy1177-54671177-5483https://doaj.org/article/60d7c8055e374631880e9018548bd7612012-12-01T00:00:00Zhttp://www.dovepress.com/iatrogenic-retinal-breaks-during-20-gauge-vitrectomy-for-proliferative-a11828https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Yumi Kamura,1 Yukihiro Sato,2 Yuzou Deguchi,3 Fumihiko Yagi31Department of Ophthalmology, Division of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan; 2Department of Diabetes Center, Jichi Medical University, Tochigi, Japan; 3Department of Ophthalmology, Toho University Sakura Medical Center, Chiba, JapanBackground: We classified iatrogenic retinal break formation during 20-gauge pars plana vitrectomy for proliferative diabetic retinopathy into three types according to the mechanism of development, and evaluated the association of each type with postoperative complications. This is the largest series of such patients published to date.Methods: This was a retrospective comparative study of 760 eyes from 609 cases who underwent primary 20-gauge vitrectomy for proliferative diabetic retinopathy and were followed-up for at least 6 months after surgery. Postoperatively, the eyes were classified as having vitreous hemorrhage only (group 1), fibrovascular membrane without traction retinal detachment (group 2), or fibrovascular membrane with traction retinal detachment (group 3).Results: The overall incidence of iatrogenic retinal breaks was 29%. Fibrovascular membrane dissection was associated with retinal break formation in 50 of the eyes in group 3, an incidence which was significantly higher than that in group 2 (P &lt; 0.001). Posterior vitreous detachment creation and peripheral vitreous shaving were associated with retinal break formation in 8% of eyes overall, and oral dialysis occurred in 2%. Postoperatively, vitreous hemorrhage requiring washout, neovascular glaucoma, recurrent retinal detachments, and fibrovascular proliferation at the sclerotomy sites occurred in 4%, 4%, 3%, and 1%, respectively, of all eyes. Outcomes of eyes with these postoperative complications, other than vitreous hemorrhage, were poor. Multiple regression analysis revealed retinal break formation during fibrovascular membrane dissection to be significantly related to postoperative vitreous hemorrhage (P = 0.019), recurrent retinal detachments (P &lt; 0.001), and neovascular glaucoma (P = 0.048). Oral dialysis was also significantly related to postoperative vitreous hemorrhage (P = 0.001).Conclusion: Iatrogenic retinal break formation during fibrovascular membrane dissection was more likely to be the cause of poor outcomes than peripheral retinal breaks or oral dialysis.Keywords: iatrogenic retinal breaks, 20-gauge vitrectomy, proliferative diabetic retinopathy, postoperative complicationsKamura YSato YDeguchi YYagi FDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2013, Iss default, Pp 29-33 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Kamura Y Sato Y Deguchi Y Yagi F Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy
description	Yumi Kamura,1 Yukihiro Sato,2 Yuzou Deguchi,3 Fumihiko Yagi31Department of Ophthalmology, Division of Visual Sciences, Nihon University School of Medicine, Tokyo, Japan; 2Department of Diabetes Center, Jichi Medical University, Tochigi, Japan; 3Department of Ophthalmology, Toho University Sakura Medical Center, Chiba, JapanBackground: We classified iatrogenic retinal break formation during 20-gauge pars plana vitrectomy for proliferative diabetic retinopathy into three types according to the mechanism of development, and evaluated the association of each type with postoperative complications. This is the largest series of such patients published to date.Methods: This was a retrospective comparative study of 760 eyes from 609 cases who underwent primary 20-gauge vitrectomy for proliferative diabetic retinopathy and were followed-up for at least 6 months after surgery. Postoperatively, the eyes were classified as having vitreous hemorrhage only (group 1), fibrovascular membrane without traction retinal detachment (group 2), or fibrovascular membrane with traction retinal detachment (group 3).Results: The overall incidence of iatrogenic retinal breaks was 29%. Fibrovascular membrane dissection was associated with retinal break formation in 50 of the eyes in group 3, an incidence which was significantly higher than that in group 2 (P &lt; 0.001). Posterior vitreous detachment creation and peripheral vitreous shaving were associated with retinal break formation in 8% of eyes overall, and oral dialysis occurred in 2%. Postoperatively, vitreous hemorrhage requiring washout, neovascular glaucoma, recurrent retinal detachments, and fibrovascular proliferation at the sclerotomy sites occurred in 4%, 4%, 3%, and 1%, respectively, of all eyes. Outcomes of eyes with these postoperative complications, other than vitreous hemorrhage, were poor. Multiple regression analysis revealed retinal break formation during fibrovascular membrane dissection to be significantly related to postoperative vitreous hemorrhage (P = 0.019), recurrent retinal detachments (P &lt; 0.001), and neovascular glaucoma (P = 0.048). Oral dialysis was also significantly related to postoperative vitreous hemorrhage (P = 0.001).Conclusion: Iatrogenic retinal break formation during fibrovascular membrane dissection was more likely to be the cause of poor outcomes than peripheral retinal breaks or oral dialysis.Keywords: iatrogenic retinal breaks, 20-gauge vitrectomy, proliferative diabetic retinopathy, postoperative complications
format	article
author	Kamura Y Sato Y Deguchi Y Yagi F
author_facet	Kamura Y Sato Y Deguchi Y Yagi F
author_sort	Kamura Y
title	Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy
title_short	Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy
title_full	Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy
title_fullStr	Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy
title_full_unstemmed	Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy
title_sort	iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/60d7c8055e374631880e9018548bd761
work_keys_str_mv	AT kamuray iatrogenicretinalbreaksduring20gaugevitrectomyforproliferativediabeticretinopathy AT satoy iatrogenicretinalbreaksduring20gaugevitrectomyforproliferativediabeticretinopathy AT deguchiy iatrogenicretinalbreaksduring20gaugevitrectomyforproliferativediabeticretinopathy AT yagif iatrogenicretinalbreaksduring20gaugevitrectomyforproliferativediabeticretinopathy
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Iatrogenic retinal breaks during 20-gauge vitrectomy for proliferative diabetic retinopathy

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