Visual and anatomical outcomes of primary retinectomy for diabetic tractional retinal detachment

Abstract

Purpose: Uncontrolled proliferative diabetic retinopathy (PDR) can cause fibrovascular growth and retinal traction, leading to tractional retinal detachment (TRD). The role of primary retinectomy in diabetic TRD remains unclear, as most studies focus on rhegmatogenous retinal detachment (RRD) with PVR. This study aims to investigate the impact of retinectomy on anatomical and visual outcomes in patients undergoing pars plana vitrectomy (PPV) for diabetic TRD.

Method: Patients who underwent primary retinectomy during PPV for diabetic TRD were retrospectively evaluated. Best corrected visual acuity (BCVA) before surgery and at the final follow-up, retinectomy characteristics, and final retinal attachment status were documented. TRD score, the quadrant and extent of the retinectomy, presence of macular displacement at final follow-up, and postoperative complications were evaluated. The relationship between the quadrants and extent of the retinectomy and visual acuity was also assessed.

Result: Thirty-eight eyes of 38 patients with mean age 60.55 ± 10.00 years were included. Mean follow-up was 23.53 ± 27.40 months. The most common locations of the retinectomy sites were extended posterior to the equator (39.5%), around the equatorial zone (34.2%), and peripheral retina (26.3%). The mean BCVA improved from 1.71 ± 0.53 logMAR to 1.48 ± 0.74 logMAR at the final follow-up. At the final visit 65.8% of patients experienced improved or maintained BCVA. Temporal retinectomy showed worse visual outcomes in the Chi-square test but not in binary logistic regression analysis. Furthermore, 26 (68.4%) eyes were attached without tamponade, 10 (26.3%) were attached under silicone oil and 2 (5.6%) remained detached under silicone oil.

Conclusion: These findings suggest that retinectomy, when deemed necessary in eyes with diabetic TRD, may not lead to poor functional and anatomical outcomes, contrary to some previous assumptions.

Keywords: Proliferative diabetic retinopathy; Retinectomy; Tractional retinal detachment.

Fig. 1

Retinectomy quadrants were categorized as nasal, temporal, superior, or inferior. If a single quadrant accounted for at least 70% of the retinectomy area, it was classified under that quadrant. In cases involving multiple quadrants, each involved quadrant was recorded separately

Fig. 2

Surgical images of a 56-year-old female patient who underwent primary retinectomy due to diabetic TRD and intraocular hemorrhage. Fundus image after completion of core vitrectomy and peripheral vitreous removal shows nearly 360-degree preretinal membranes and intrinsic retinal shortening (a). After removal of preretinal membranes, persistent intrinsic retinal shortening is observed, and perfluorodecalin is injected. Retinectomy margins are marked with endo-cautery and the retinectomy is performed using a cutter, followed by removal of the residual anterior retina (b). Endolaser photocoagulation is applied to the retinectomy margins and the peripheral retina beyond the arcades (c, d). Following silicone oil removal, the final fundus image at the last follow-up is presented, with the patient’s visual acuity recorded as 20/200. (e)