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. 2021 May;41(5):1717-1727.
doi: 10.1007/s10792-021-01730-3. Epub 2021 Feb 4.

Trimanual vitrectomy for severe proliferative diabetic retinopathy

Samir Mohammed El-Baha  1 , Islam S H Ahmed  2
Affiliations

Trimanual vitrectomy for severe proliferative diabetic retinopathy

Samir Mohammed El-Baha et al. Int Ophthalmol. 2021 May.

Abstract

Purpose: To describe and evaluate a novel technique of pars plana vitrectomy (PPV) under chandelier illumination which is aided with the vital dyes and perfluorocarbon liquids for the management of the complex diabetic vitrectomy cases.

Methods: We conducted a prospective interventional comparative study on 40 eyes of 36 patients with advanced diabetic eye disease requiring PPV. The study was conducted in a single tertiary referral center. Eyes were divided on 1:1 basis by stratified randomization into two groups. Group 1 had trimanual vitrectomy done assisted with chandelier illumination, perfluorocarbon liquid (PFCL) and vital dyes. Group 2 had the conventional bimanual vitrectomy done assisted with chandelier illumination only. All patients were followed up for a minimum of 6 months after the surgery.

Results: Forty eyes of 36 patients with the mean age of 51.42 years (range 28-69) were evaluated. The anatomical success at 6 months could be achieved in all the eyes in both groups. The complete removal of the pre-retinal proliferations could be accomplished in all the eyes in the trimanual PPV group, and only in 85% of the eyes in the bimanual PPV group. Operative time was significantly shorter in the trimanual PPV group (p < 0.001). More eyes in the trimanual PPV group (55.0%) could achieve better vision (> 6/60) 6 months after the operation compared to the bimanual PPV group (50.0%), but this difference was not statistically significant.

Conclusion: Trimanual PPV is a novel, safe and effective technique that can improve the results of the complex diabetic PPV.

Keywords: Diabetic vitrectomy; Pars plana vitrectomy; Perfluorocarbon liquids; Vital dyes.

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