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. 2023 Feb 21;16(1):18-22.
doi: 10.4103/ojo.ojo_348_21. eCollection 2023 Jan-Apr.

Evaluation of twenty-seven-gauge vitrectomy for complex proliferative diabetic retinopathy

Saurabh Verma  1 , Hannah Shiny  1 , Shorya Vardhan Azad  1 , Vinod Kumar  1
Affiliations

Evaluation of twenty-seven-gauge vitrectomy for complex proliferative diabetic retinopathy

Saurabh Verma et al. Oman J Ophthalmol. .

Abstract

Purpose: To evaluate the outcomes of twenty-seven-gauge (27G) vitrectomy in cases with complex proliferative diabetic retinopathy (PDR).

Methods: This was a retrospective interventional study of eyes that underwent 27G vitrectomy for complex PDR. The demographic profile, history, examination findings, and intraoperative surgical steps (especially use of other instruments such as intravitreal scissors/forceps) were reviewed. All the eyes were followed up for a minimum of 3 months at 1-week, 1-month, and 3-month interval. Visual acuity, intraocular pressure (IOP), and retinal status were documented at every follow-up.

Results: Nineteen eyes of 17 patients with complex PDR were included in the study. Seven eyes had tractional retinal detachment involving the macula, three had tractional retinal detachment threatening the macula, one had secondary rhegmatogenous retinal detachment, and eight eyes had nonresolving vitreous hemorrhage along with thick fibrovascular proliferation (FVP) at posterior pole. Anatomical attachment was seen in all cases at the end of follow-up with a single surgery. Visual acuity improved from logMAR 2.5 preoperatively to logMAR 1.01 at 3 months (P = 0.0003). None of the cases required use of intravitreal scissors/forceps for the removal of FVP. Early postoperative vitreous hemorrhage was seen in two eyes. Hypotony was not seen in any eye, while increased IOP was seen in five eyes.

Conclusion: 27G vitrectomy is a safe and effective technique in cases with complex diabetic surgery. Due to smaller size cutter, it offers advantages in the dissection of tissue and is associated with lower incidence of early postoperative hemorrhage.

Keywords: Diabetes mellitus; fibrovascular proliferation; pars plana vitrectomy; tractional retinal detachment; twenty-seven gauge.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
(a) Large FVP at posterior pole with localized TRD with VPT. (b-g) Insertion of vitrectomy cutter tip between retina and FVP and segmentation. (h) Complete removal of traction and two iatrogenic breaks. FVP: Fibrovascular proliferation, TRD: Tractional retinal detachment, VPT: Vitreopapillary traction
Figure 2:
Figure 2:
A 57-year-old male presented with secondary rhegmatogenous retinal detachment and SRB (a). Diathermy of retina over the SRB (b). Grasping of SRB with twenty-seven-gauge end grasping forceps and its removal (c). SRB: Subretinal band
Figure 3:
Figure 3:
A 27-year-old male with type 1 diabetes presented with vitreous hemorrhage with FVP with TRD (a). Thick FVP nasal to disc with its subsequent cutting and complete removal in (b and c). FVP: Fibrovascular proliferation, TRD: Tractional retinal detachment
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