Journal List > J Korean Ophthalmol Soc > v.52(3) > 1008988

Han, Sohn, Lee, and Nam: Effect of 23-gauge Sutureless Vitrectomy & Preoperative Bevacizumab on Results of Diabetic Vitrectomy

Abstract

Purpose

To investigate the results of 23-gauge sutureless vitrectomy and preoperative bevacizumab in diabetic retinopathy cases.

Methods

A total of 212 eyes received pars plana vitrectomy by a single surgeon for proliferative diabetic retinopathy and were followed up for at least 6 months. The change of visual acuity and operative complications among the 20-gauge vitrectomy (group I, 86 eyes), 23-gauge vitrectomy (group II, 30 eyes), and 23-gauge vitrectomy with preoperative intravitreal bevacizumab (IVB) injection (group III, 96 eyes) were retrospectively analyzed.

Results

One month postoperatively, visual improvement was better in groups II and III than in group I. Three months postoperatively, visual improvement was better in group III than in groups I and II. Six months postoperatively, visual improvement in group III was better than in group I, but there was no significant difference between group II and III. Intraoperative retinal breaks and postoperative vitreous hemorrhage were less common in group III than in groups I and II.

Conclusions

In patients with proliferative diabetic retinopathy, 23-gauge sutureless vitrectomy showed faster visual re-covery compared with 20-gauge vitrectomy, and vitrectomy with preoperative bevacizumab had less intraoperative and postoperative complications than vitrectomy without preoperative bevacizumab.

References

1. Mason JO 3rd, Colagross CT, Haleman T, et al. Visual outcome and risk factors for light perception and no light perception vision after vitrectomy for diabetic retinopathy. Am J Ophthalmol. 2005; 140:231–5.
crossref
2. Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study (DRVS) report #1. Ophthalmology. 1985; 92:482–502.
3. Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology. 1983; 90:522–30.
4. Hershberger VS, Augsburger JJ, Hutchins RK, et al. Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with re-current vitreous hemorrhage: ultrasound biomicroscopy findings. Ophthalmology. 2004; 111:1215–21.
5. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002; 109:1807–12. discussion 1813.
6. Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002; 109:1814–20.
7. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25:208–11.
crossref
8. Yang SK, Yoon SY, Kim JG, Yoon YH. Transconjunctival sutureless vitrectomy for the treatment of vitreoretinal complications in patients with diabetes mellitus. Ophthalmic Surg Lasers Imaging. 2009; 40:461–6.
crossref
9. Park DH, Shin JP, Kim SY. Comparison of clinical outcomes between 23-gauge and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy. Retina. 2010; 30:1662–70.
crossref
10. Shin MK, Kim NM, Lee JE, Oum BS. Intravitreal bevacizumab injection as preoperative adjuvant of vitrectomy for proliferative diabetic retinopathy. J Korean Ophthalmol Soc. 2009; 50:731–7.
crossref
11. da R Lucena D, Ribeiro JA, Costa RA, et al. Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study). Br J Ophthalmol. 2009; 93:688–91.
crossref
12. Jeon GS, Han JR, Nam WH, Kim HK. Effectiveness of pre-operative intravitreal bevacizumab injections in pars plana vitrectomy for proliferative diabetic retinopathy. J Korean Ophthalmol Soc. 2009; 50:1221–5.
crossref
13. Rizzo S, Genovesi-Ebert F, Di Bartolo E, et al. Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy (PDR). Graefes Arch Clin Exp Ophthalmol. 2008; 246:837–42.
crossref
14. Modarres M, Nazari H, Falavarjani KG, et al. Intravitreal injection of bevacizumab before vitrectomy for proliferative diabetic retinopathy. Eur J Ophthalmol. 2009; 19:848–52.
crossref
15. Ahmadieh H, Shoeibi N, Entezari M, Monshizadeh R. Intravitreal bevacizumab for prevention of early postvitrectomy hemorrhage in diabetic patients: a randomized clinical trial. Ophthalmology. 2009; 116:1943–8.
16. Oshima Y, Shima C, Wakabayashi T, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology. 2009; 116:927–38.
crossref
17. Sebag J. Diabetic vitreopathy. Ophthalmology. 1996; 103:205–6.
crossref
18. Kim MJ, Park KH, Hwang JM, et al. The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy Korean. J Ophthalmol. 2007; 21:201–7.
18. Lott MN, Manning MH, Singh J, et al. 23-gauge vitrectomy in 100 eyes: short-term visual outcomes and complications. Retina. 2008; 28:1193–200.
19. Arumí JG, Boixadera A, Martínez-Castillo V, Corcóstegui B. Transconjunctival sutureless 23-gauge vitrectomy for diabetic retinopathy. Review. Curr Diabetes Rev. 2009; 5:63–6.
20. Ku M, Sohn HJ, Lee DY, Nam DH. Sclerotomy-related retinal breaks in vitrectomy for proliferative diabetic retinopathy: 20- vs 23-gauge systems. J Korean Ophthalmol Soc. 2009; 50:1066–70.
crossref
21. Okamoto F, Okamoto C, Sakata N, et al. Changes in corneal topography after 25-gauge transconjunctival sutureless vitrectomy versus after 20-gauge standard vitrectomy. Ophthalmology. 2007; 114:2138–41.
crossref
22. Azar-Arevalo O, Arevalo JF. Corneal topography changes after vitreoretinal surgery. Ophthalmic Surg Lasers. 2001; 32:168–72.
crossref
23. Avery RL, Pearlman J, Pieramici DJ, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006; 113:1695.
crossref
24. Moradian S, Ahmadieh H, Malihi M, et al. Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2008; 246:1699–705.
crossref
25. Spaide RF, Fisher YL. Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina. 2006; 26:275–8.
crossref

Table 1.
Preoperative characteristics
  Group 1
Group 2
Group 3
p-value
20 G vitrectomy (n = 86) 23 G sutureless vitrectomy (n = 30) Intravitreal bevacizumab/23 G sutureless vitrectomy (n = 96)
No. of eyes 86 30 96  
No. of patient (Male:Female) 75 (36/39) 27 (14/13) 81 (44/37) 0.387 ††
        0.805††0.287†††
Mean age (mean ± SD, yr) 56.2 ± 9.2 54.2 ± 10.2 53.9 ± 11.6 0.148 ∗∗
        0.241∗∗
        0.085∗∗∗
Duration of diabetes (mean ± SD, yr) 14.3 ± 9.5 13.6 ± 7.7 12.9 ± 8.0 0.649
        0.977∗∗
        0.461∗∗∗
Type 1/Type 2 DM 5/70 2/25 5/76 0.436
        0.919††
        0.368†††
HbA1c (mean±SD, %) 8.36 ± 1.73 8.35 ± 0.75 8.36 ± 1.04 0.126 ∗∗
        0.730∗∗
        0.238∗∗∗
Chronic renal failure (%)       0.896
        0.710††
        0.733†††
 Absent 55 (73.3%) 21 (77.8%) 58 (71.6%)  
 Present 20 (26.7%) 6 (22.2%) 23 (28.4%)  
Hypertension (%)       0.647
        0.905††
        0.412†††
 Absent 34 (45.3%) 11 (40.7%) 35 (43.2%)  
 Present 41 (54.7%) 16 (59.3%) 46 (56.8%)  
Preoperative PRP (%) 60 (69.8%) 21 (70.0%) 67 (69.8%) 0.280†††
        0.276††
        0.997†††
Lens status       0.713
        0.922††
        0.694†††
 Phakic 66 (76.8%) 24 (80.0%) 76 (79.2%)  
 Pseudophakic 20 (23.2%) 6 (20.0%) 20 (20.8%)  
 Preoperative BCVA (mean ± SD, logMAR) 1.66 ± 0.50 1.64 ± 0.44 1.61 ± 0.52 0.573 ∗∗
        0.617∗∗
        0.948∗∗∗
Preoperative IOP (mean ±SD, mmHg) 14.0 ± 3.7 12.4 ± 2.2 13.8 ± 2.3 0.085∗∗∗
        0.708∗∗
        0.155∗∗∗
Preoperative bleeding (mean ± SD) 1.40 ± 0.76 1.37 ± 0.72 1.43 ± 0.76 0.551∗∗∗
        0.702∗∗
        0.281∗∗∗
Surgical indication       0.989
        0.977††
        0.994†††
 Vitreous hemorrhage 30 (34.8%) 10 (33.3%) 35 (36.5%)  
 Progressive fibrovascular proliferation 5 (5.8%) 2 (6.7%) 5 (5.2%)  
 Vitreous hemorrhage & progressive fibrovascular proliferation 35 (40.8%) 13 (43.3%) 39 (40.6%)  
 Tractional retinal detachment 16 (18.6%) 5 (16.7%) 17 (17.7%)  

Data are number or mean ± SD.

Student t-test between Group 1 and Group 2;

∗∗ Student t-test between Group 2 and Group 3;

∗∗∗ Student t-test between Group 1 and Group 3;

Chi-squrae test between Group 1 and Group 2;

†† Chi-squrae between Group 2 and Group 3;

††† Chi-squrae between Group 1 and Group 3. Vitreous hemorrhage grading; No vitreous hemorrhage (grade 0), Mild to Moderate vitreous hemorrhage with visible fundus details (grade 1), Severe vitreous hemorrhage with no retinal details and no orange fundus reflex (grade 2).

Table 2.
Change between preoperative and postoperative best-corrected visual acuity (logMAR)
  Group 1
Group 2
Group 3
p-value
20 G vitrectomy (n = 86) 23 G Sutureless vitrectomy (n = 30) Intravitreal bevacizumab/23 G sutureless vitrectomy (n = 96)
Preop-1 month (mean ± SD) 0.55 ± 0.52 0.78 ± 0.44 0.85 ± 0.51 0.021 0.544 0.001
Preop-3 months (mean ± SD) 0.72 ± 0.58 0.84 ± 0.35 0.99 ± 0.48 0.1850.0210.003
Preop-6 months (mean ± SD) 0.90 ± 0.70 1.01 ± 0.56 1.11 ± 0.45 0.643 0.2200.045

Student t-test between Group 1 and Group 2;

Student t-test between Group 2 and Group 3;

Student t-test between Group 1 and Group 3.

Table 3.
Intraoperative and postoperative complications
  Group 1
Group 2
Group 3
p-value
20 G vitrectomy (n = 86) 23 G sutureless vitrectomy (n = 30) I s Intravitreal bevacizumab/23 G sutureless vitrectomy (n = 96)
Intraoperative complications        
 Iatrogenic retinal breaks (%) 9 (10.5 %) 3 (10%) 4 (4.2%) 0.8080.022††
        <0.001†††
 Posterior capsule tear with safe sulcus IOL implantation 4 (4.7%) 0 (0%) 3 (3.1%) 0.2970.439††0.709†††
 Lens material in vitreous 1 (1.2%) 0 (0%) 0 (0%) 0.7410.925††
        0.473†††
Postoperative complications        
 Early postoperative vitreous hemorrhage (mean score ± SD) 0.27 ± 0.54 0.20 ± 0.55 0.08 ± 0.38 0.366 0.014∗∗ <0.001∗∗∗
 Late postoperative vitreous hemorrhage (mean score ± SD) 0.24 ± 0.55 0.13 ± 0.50 0.03 ± 0.18 0.080 0.001∗∗ <0.001∗∗∗
 Neovascular glaucoma 4 (4.7%) 1 (3.3%) 1 (1.0%) 0.645 0.023††
        0.009†††
 Progressing fibrovascular proliferation 3 (3.5%) 1 (3.3%) 2 (2.1%) 0.7250.561††
        0.668†††
 Recurrent retinal detachment 3 (3.5%) 0 (0%) 2 (2.1%) 0.4040.579††
        0.668†††
 Hyphaema 3 (3.5%) 0 (0%) 2 (2.1%) 0.4040.579††
        0.668†††
 Low IOP (<6 mmHg) 1 (1.2%) 0 (0%) 1 (1.0%) 0.7410.762††
        0.723†††
 IIOP (>30 mmHg) 4 (4.7%) 1 (3.3%) 2 (2.1%) 0.6140.561††
        0.424†††
Vitreoretinal reoperation 1 (1.2%) 0 (0%) 1 (1.0 %) 0.7410.762††
        0.723†††

Student t-test between Group 1 and Group 2,

∗∗ Student t-test between Group 2 and Group 3,

∗∗∗ Student t-test between Group 1 and Group 3

Chi-squrae test between Group 1 and Group 2,

†† Chi-squrae between Group 2 and Group 3,

††† Chi-squrae between Group 1 and Group 3 Vitreous hemorrhage grading; No vitreous hemorrhage (grade 0), Mild to Moderate vitreous hemorrhage with visible fundus details (grade 1), Severe vitreous hemorrhage with no retinal details and no orange fundus reflex (grade 2).

Table 4.
Surgical procedures
  Group 1
Group 2
Group 3
p-value
20 G vitrectomy (n = 86) 23 G sutureless vitrectomy (n = 30) Intravitreal bevacizumab/23 G sutureless vitrectomy (n = 96)
Endolaser photocoagulation (%) 73 (84.9%) 26 (86.7%) 85 (88.5%) 0.812
        0.782††
        0.566†††
Tamponade (%)        
 Silicone oil 25 (29.1%) 5 (16.7%) 12 (12.5%) 0.182
        0.560††
        0.006††
 Gas 9 (10.4%) 4 (13.3%) 11 (11.5%) 0.668
        0.782††
        0.831††
 Air 0 (%) 1 (3.3%) 5 (5.2%) 0.089
        0.674††
        0.032††
 BSS 52 (60.5%) 20 (66.7%) 68 (70.8%) 0.878
        0.664††
        0.409††
Phacoemulisication (%) 61 (70.9%) 24 (80.0%) 76 (79.2%) 0.657
        0.831††
        0.645††

Chi-squrae test between Group 1 and Group 2;

†† Chi-squrae between Group 2 and Group 3;

††† Chi-squrae between Group 1 and Group 3.

TOOLS
Similar articles