Effect of 23-gauge Sutureless Vitrectomy & Preoperative Bevacizumab on Results of Diabetic Vitrectomy

Dae Heon Han; Hee Jin Sohn; Dae Young Lee; Dong Heun Nam

doi:10.3341/jkos.2011.52.3.285

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

Original Article

J Korean Ophthalmol Soc 2011;52(3):285-292.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.3.285

Effect of 23-gauge Sutureless Vitrectomy & Preoperative Bevacizumab on Results of Diabetic Vitrectomy

Dae Heon Han, MD¹, Hee Jin Sohn, MD, PhD², Dae Young Lee, MD¹, Dong Heun Nam, MD, PhD¹

¹Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea

²Department of Ophthalmology, Hongik Hospital, Seoul, Korea

Address reprint requests to Dong Heun Nam, MD, PhD Department of Ophthalmology, Gachon University Gil Hospital #1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: eyedawns@gilhospital.com

Received 15 July 201014 October 2010 Accepted 17 January 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: 20-gauge vitrectomy, 23-gauge vitrectomy, Intravitreal bevacizumab injection

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

17. Sebag J. Diabetic vitreopathy. Ophthalmology. 1996; 103:205–6.

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.

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.

22. Azar-Arevalo O, Arevalo JF. Corneal topography changes after vitreoretinal surgery. Ophthalmic Surg Lasers. 2001; 32:168–72.

23. Avery RL, Pearlman J, Pieramici DJ, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006; 113:1695.

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.

25. Spaide RF, Fisher YL. Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina. 2006; 26:275–8.

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)	p-value
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)	p-value
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	0.185^∗0.021^†0.003^‡
Preop-6 months (mean ± SD)	0.90 ± 0.70	1.01 ± 0.56	1.11 ± 0.45	0.643^∗ 0.220^†0.045^‡

^∗ 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)	p-value
Intraoperative complications
Iatrogenic retinal breaks (%)	9 (10.5 %)	3 (10%)	4 (4.2%)	0.808^†0.022^††
				<0.001^†††
Posterior capsule tear with safe sulcus IOL implantation	4 (4.7%)	0 (0%)	3 (3.1%)	0.297^†0.439^††0.709^†††
Lens material in vitreous	1 (1.2%)	0 (0%)	0 (0%)	0.741^†0.925^††
				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%)	0.725^†0.561^††
				0.668^†††
Recurrent retinal detachment	3 (3.5%)	0 (0%)	2 (2.1%)	0.404^†0.579^††
				0.668^†††
Hyphaema	3 (3.5%)	0 (0%)	2 (2.1%)	0.404^†0.579^††
				0.668^†††
Low IOP (<6 mmHg)	1 (1.2%)	0 (0%)	1 (1.0%)	0.741^†0.762^††
				0.723^†††
IIOP (>30 mmHg)	4 (4.7%)	1 (3.3%)	2 (2.1%)	0.614^†0.561^††
				0.424^†††
Vitreoretinal reoperation	1 (1.2%)	0 (0%)	1 (1.0 %)	0.741^†0.762^††
				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)	p-value
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.

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