LONG-TERM RESULTS OF VITRECTOMY WITHOUT ENDOTAMPONADE IN PROLIFERATIVE DIABETIC RETINOPATHY WITH TRACTIONAL RETINAL DETACHMENT

Purpose: The purpose of this study was to evaluate the long-term results of vitreoretinal surgery without use of intraocular silicone oil or gas in patients with proliferative diabetic retinopathy and tractional retinal detachment. Methods: A clinical interventional case-series study was conducted of 168 eyes of 150 patients with diabetic tractional retinal detachment who were consecutively treated by pars plana vitrectomy without endotamponade during a study period of 7 years. Per selection criterion, retinal defects did not develop or were not observed in any of the study participants before or during surgery. The surgery included pars plana vitrectomy, removal of epiretinal membranes, and retinal endolaser coagulation. Combined cataract surgery was performed in 33 eyes (20%). The mean follow-up was 23 +/- 14 months (range, 12-65 months). Results: In 158 eyes (94%), the retina reattached after surgery and remained attached until the end of follow-up. Subretinal fluid absorbed completely within 2 months after surgery. Best-corrected visual acuity improved in 126 eyes (75%) and remained unchanged in 19 eyes (11%). Mean best-corrected visual acuity improved from 2.22 +/- 1.22 at baseline to 1.24 +/- 1.00 at final follow-up (P < 0.001). At the end of follow-up, 11 eyes (7%) showed iris neovascularization, and 9 of these 11 eyes developed iris neovascularization after surgery. In multivariate logistic regression, the only factor associated with postoperative rubeosis iridis was preexisting rubeosis iridis (odds ratio, 6.4). Conclusion: Vitreoretinal surgery for tractional retinal detachment in proliferative diabetic retinopathy may not necessarily be combined with an ocular endotamponade if there were no pre- or intraoperative retinal breaks. RETINA 30: 447-451, 2010