Comparison of Combined and Consecutive Surgery for Patients with Proliferative Diabetic Retinopathy and Severe Cataract

2019 ◽  
Author(s):  
Fei Liu ◽  
Yan Teng ◽  
Yan Shao ◽  
Ximei Chen ◽  
Miao Zhao ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Demographic Data ◽  
Anterior Segment ◽  
Vitreous Hemorrhage ◽  
Panretinal Photocoagulation ◽  
Combined Surgery ◽  
Iol Implantation ◽  
Surgery Group ◽  
Significant Difference

Abstract Objective: To investigate the safety, effectiveness and differences of combined and consecutive surgical strategies on patients with proliferative diabetic retinopathy (PDR) and severe cataract. Methods: Eighty-four cases (84 eyes) with PDR complications of vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) and severe cataract were enrolled in this retrospective analysis. Thirty-nine eyes in consecutive surgery group underwent the surgery of phacoemulsification (PHACO) and intraocular lens (IOL) implantation firstly, and then received the surgery of vitrectomy, panretinal photocoagulation (PRP) and retinopexy (when necessary) two to twenty-five days later. Forty-five eyes in combined surgery group underwent the combined surgery of PHACO, IOL implantation, vitrectomy, PRP and retinopexy (when necessary). The postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior segment inflammation responses, and surgical complications were chosen as outcome measurements when the two groups were compared. Results: The demographic data of the patients before surgery had no significant difference between the two groups. There was no statistically significant difference on BCVA at postoperative week 6 between two groups (P>0.05). Postoperative inflammation of the anterior segment in combined surgery group was much more serious than that in consecutive surgery group. 91.1% patients (41 eyes) developed moderate or serious inflammation in combined surgery group at postoperative day 3 compared with 46.2% patients (18 eyes) in consecutive surgery group. In addition, there were still 71.1% patients (32 eyes) with mild or moderate inflammation in combined surgery group at postoperative week 6 compared with 28.2% patients (11 eyes) in consecutive surgery group. The IOP elevated in 20 eyes (44.4%) in combined surgery group and seven eyes (17.9%) in consecutive surgery group. The presence of posterior synechia was found in 10 eyes (22.2%) in combined group and one eye (2.6%) in consecutive group 6 weeks after surgery. Conclusion: Although both surgery strategies for PDR patients with severe cataract are safe and effective, combined surgery leads to more postoperative complications than consecutive surgery, which should be carefully monitored and properly treated. For PDR patients with severe cataract which perturbs the vitrectomy and PRP, the consecutive surgery is a priority for surgery choice if the patient's condition allows.

Endolaserless Vitrectomy With Intravitreal Aflibercept Injection for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage (LASER LESS TRIAL)

2018 ◽  
Vol 2 (3) ◽  
pp. 127-137
Author(s):  
Dennis M. Marcus ◽  
Harinderjit Singh ◽  
Davis C. Starnes ◽  
Harveen Walia ◽  
Amina Farooq ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Panretinal Photocoagulation ◽  
Short Term ◽  
Safety And Efficacy ◽  
Intravitreal Aflibercept ◽  
Central Subfield Thickness ◽  
Endothelial Growth Factor

Purpose: For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy. Methods: Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI. Main Outcome Measures: Herein, we present pooled safety and efficacy outcomes through 4 months. Results: Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months. Conclusions: Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.

scholarly journals Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kei Takayama ◽  
Hideaki Someya ◽  
Hiroshi Yokoyama ◽  
Yoshihiro Takamura ◽  
Masakazu Morioka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Multicenter Study ◽  
Vitreous Hemorrhage ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
Uncontrolled Diabetes ◽  
Surgical Options ◽  
25 Gauge Vitrectomy

Abstract Neovascular glaucoma (NVG) is a terminal severe complication in eyes with proliferative diabetic retinopathy (PDR), and PDR eyes with vitreous hemorrhage (VH) which undergo vitrectomy may have higher risk of postoperative NVG. The incidence and the prognostic factor of postoperative NVG after 25-gauge vitrectomy with advanced surgical options remain unclear. We retrospectively reviewed medical records of 268 eyes of 268 consecutive PDR patients with VH who underwent 25-gauge vitrectomy and 12 months follow-up at seven centers. Preoperative ocular factors (visual acuity, tractional retinal detachment, panretinal photocoagulation [PRP]), demographics and clinical factors (sex, age, diabetic duration, HbA1c, hypertension, anticoagulant medication, and kidney function), surgical procedures, and postoperative complications were compared between patients who developed postoperative NVG (9.3%) and those who did not. NVG eyes was significantly younger (P = 0.026), had shorter diabetic duration (P = 0.022), higher HbA1c (P = 0.028), absence of PRP (P = 0.039) and higher frequency of postoperative VH (P = 0.0075) than non-NVG eyes. Logistic regression analysis identified postoperative VH (P = 0.014), shorter diabetic duration (P = 0.029), and no PRP (P = 0.028) as prognostic factors for postoperative NVG. This multicenter study indicates that younger age, uncontrolled diabetes, no PRP, and postoperative VH are risk factors of post-vitrectomy NVG.

Ocular Pulse Amplitude after Panretinal Photocoagulation in Normotensive Eyes with Proliferative Diabetic Retinopathy

2016 ◽  
Vol 27 (4) ◽  
pp. 481-484
Author(s):  
Marija M. Bozic ◽  
Jelena B. Karadzic ◽  
Igor M. Kovacevic ◽  
Ivan S. Marjanovic
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Laser Photocoagulation ◽  
Argon Laser ◽  
Pulse Amplitude ◽  
Panretinal Photocoagulation ◽  
Ocular Pulse Amplitude ◽  
Diabetes Mellitus Type Ii ◽  
Significant Difference ◽  
Ocular Pulse

Purpose To assess the effect of panretinal laser photocoagulation on ocular pulse amplitude (OPA) in normotensive eyes with proliferative diabetic retinopathy. Methods Prospectively, we performed unilateral argon laser panretinal photocoagulation (PRP) in 30 patients with diabetes mellitus type II and previously untreated bilateral proliferative diabetic retinopathy. Before and 7 and 30 days after the treatment, OPA was measured using dynamic contour tonometer. Results Compared with the untreated contralateral eyes, laser photocoagulation led to a reduction of OPA. Ocular pulse amplitude did not significantly differ in photocoagulated eyes 7 days after the treatment, but there was a significant difference in OPA 30 days after the treatment. The decrease in OPA values was 15% 7 days after PRP and 40% 30 days after PRP. Conclusions Ocular pulse amplitude reduction after PRP indirectly informs us about choriocapillary closure, already reported in previous studies.

scholarly journals Single-Session Low Duration Panretinal Photocoagulation Using Conventional Laser on Central Subfield Macular Thickness in Diabetic Retinopathy

2018 ◽  
Vol 12 (1) ◽  
pp. 308-313
Author(s):  
Arief S Kartasasmita ◽  
Prettyla Yollamanda ◽  
Grimaldi Ihsan ◽  
Rova Virgana
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Controlled Trial ◽  
Macular Thickness ◽  
Panretinal Photocoagulation ◽  
Single Session ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Conventional Laser

Objective:To compare the change in central subfield macular thickness following single-session and multiple-session laser panretinal photocoagulation in subjects with diabetic retinopathy.Methods:A single-center, randomized controlled trial study was performed on 28 eyes of 16 patients with severe non-proliferative diabetic retinopathy or proliferative diabetic retinopathy. Eyes were randomly assigned for treatment with panretinal photocoagulation performed either in single-session or multiple-session divided into three sessions during two-week period. Central subfield macular thickness was quantified using spectral domain optical coherence tomography and changes at four weeks follow-up were compared to the baseline measurement.Result:Mean baseline central subfield macular thickness of 12 eyes underwent single-session and 16 eyes underwent multiple-session panretinal photocoagulation were 342.91+109.51 micrometers and 354+171.79 micrometers (p> .05), respectively. Mean post laser central subfield macular thickness in the single-session group was 305.83+81.95 micrometers and 389.75+229.51 micrometers in the multiple-session group (p> .05). Mean central subfield macular thickness changes four weeks post laser was 37.08+94.21 micrometers for eyes treated with single-session and -35.75+123.62 micrometers for the multiple-session treated eyes (p= .101).Conclusion:There was no significant difference in change of central subfield macular thickness at four weeks post laser from treatment with single-session and multiple-session panretinal photocoagulation. Single-session panretinal photocoagulation can be used as effective multiple-session panretinal photocoagulation for the treatment of diabetic retinopathy.

scholarly journals Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy

JAMA ◽  
2020 ◽  
Vol 324 (23) ◽  
pp. 2383
Author(s):  
Andrew N. Antoszyk ◽  
Adam R. Glassman ◽  
Wesley T. Beaulieu ◽  
Lee M. Jampol ◽  
Chirag D. Jhaveri ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Panretinal Photocoagulation

Results of Anti-VEGF Therapy in the Treatment of Post-vitrectomy Vitreous Hemorrhage in Patients with Proliferative Diabetic Retinopathy

2021 ◽  
pp. 97-103
Author(s):  
O. O. Putiienko
Keyword(s):  
Diabetic Retinopathy ◽  
Gas Exchange ◽  
Recurrence Rate ◽  
Proliferative Diabetic Retinopathy ◽  
Treatment Options ◽  
Vitreous Hemorrhage ◽  
Main Group ◽  
Control Group ◽  
Anti Vegf ◽  
Significant Difference

Post-vitrectomy vitreous hemorrhage in patients with proliferative diabetic retinopathy (PDR) occurs in up to 75% of cases, and this highlights the need to search for new treatment options. The aim. To analyze the results of anti-VEGF therapy in the treatment of post-vitrectomy vitreous hemorrhage in patients with PDR. Materials and methods. Seventy-eight patients (78 eyes) were examined. Twenty patients (20 eyes) of the control group underwent outpatient fluid gas exchange (OFGE) with 20% gas-air mixture of perfluoropropane for the treatment of post-vitrectomy vitreous hemorrhage. The first main group included 28 patients in whom OFGE with the same mixture was supplemented by the injection of Lucentis at a dose of 0.5 mg into the vitreous cavity. The second main group included 30 patients who achieved Eylea at a dose of 2 mg in addition to the OFGE. Results. Within 2 months, no significant difference between groups in achieving vitreous transparency or in vitreous hemorrhage recurrence rate was found. After 6 months, the frequency of vitreous hemorrhage recurrence in the control group was significantly higher (χ2 = 4.27; p = 0.039) than that in the Lucentis group (9 eyes [45%] vs. 3 eyes [10.7%]). When using Eylea in the same period, the recurrence rate was 6.7% (2 eyes) which is significantly lower than 45% (9 eyes) in the control group (χ2 = 4.59; p = 0.032). Conclusions. The effectiveness of treatment of post-vitrectomy vitreous hemorrhage by OFGE with 20% gas-air mixture of perfluoropropane within 6 months of observation is 85.5%. The use of Lucentis increases the effectiveness to 92.8% with a recurrence rate of 10.7%, and the use of Eylea to 96.6% with a recurrence rate of 6.7%. There are no significant differences between the use of Lucentis and Eylea. Keywords: proliferative diabetic retinopathy, post-vitrectomy vitreous hemorrhage, outpatient fluid gas exchange, Lucentis, Eylea.

scholarly journals Longitudinal neovascular changes on optical coherence tomography angiography in proliferative diabetic retinopathy treated with panretinal photocoagulation alone versus with intravitreal conbercept plus panretinal photocoagulation: a pilot study

Eye ◽  
2019 ◽  
Vol 34 (8) ◽  
pp. 1413-1418 ◽  
Author(s):  
Feng He ◽  
Weihong Yu
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Pilot Study ◽  
Proliferative Diabetic Retinopathy ◽  
Optical Coherence Tomography Angiography ◽  
Combination Group ◽  
Panretinal Photocoagulation ◽  
Optical Coherence ◽  
Fundus Fluorescein Angiography ◽  
Significant Difference

Abstract Purpose To investigate the longitudinal changes in neovascularization of the retinal elsewhere (NVE) size on optical coherence tomography angiography (OCTA) in proliferative diabetic retinopathy (PDR) treated by panretinal photocoagulation (PRP) alone or by single intravitreal conbercept injection plus PRP. Methods A prospective pilot study. Forty-four PDR eyes with NVE confirmed by fundus fluorescein angiography (FFA) and OCTA were included. They were assigned to receive PRP alone (PRP group) or intravitreal conbercept injection plus PRP (combination group). Ophthalmic examinations, including BCVA and OCTA to measure the NVE size, were performed at baseline before each PRP session, and at 1, 3, and 6 months. Results Twenty-nine eyes were included in the PRP group, and 15 eyes were included in the combination group. There was no significant difference between the two groups with respect to age, BCVA, and NVE area at baseline. In both groups, there was a significant (P < 0.05) NVE size reduction during the majority of study visits, with the reduction observed in the combination group significantly larger than that in the PRP group. No significant BCVA changes were observed in either groups, except that in the PRP group, the BCVA at 3 months was significantly improved (P < 0.05). No deaths or unexpected adverse events (AEs) were reported. Conclusions Intravitreal conbercept plus PRP was more effective than PRP monotherapy in NVE regression. Precise quantification of the NVE area by OCTA makes it a useful tool for monitoring the response of retinal neovascular lesions to the therapy.

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