>Cirugía y Cirujanos
>Year 2012, Issue 6
Lima-Gómez V, Mijangos-Medina LF, Hernández-Orgaz JJ, Bermúdez-Zapata DA
Efficacy of vitreorretinal surgery to improve best corrected visual acuity in diabetics with retinopathy
Cir Cir 2012; 80 (6)
PDF: 162.92 Kb.
[Full text - PDF]
Background: complications of proliferative diabetic retinopathy require surgical treatment. In 2007 Flaxel reported visual improvement after vitreoretinal surgery in 37% of Latino diabetics; in our country it is estimated that a higher proportion of patients improves, but this has not been documented. Aim: to identify the efficacy of vitreoretinal surgery for improving best corrected visual acuity, in diabetic patients treated at a hospital in Mexico City.
Methods: an observational, longitudinal, retrospective, descriptive study was conducted in diabetics who underwent vitreoretinal surgery (2007-2010) with one year follow-up. Visual acuity was measured before surgery and one year after, and it was registered when the retinopexy orphacoemulsification was performed, or silicone tamponade wasused. The proportions and 95% confidence intervals (CI) of patients whose visual acuity improved, did not change or worsened, were compared with those reported by Flaxel in Latino patients (χ2, relative risk [RR]).
Results: 63 patients, mean age 58.5 ± 11.6 years, 26 with retinal detachment (41.3%), phacoemulsification was performed in 50 (79.4%), and silicone was used in 27 (42.9%). BCVA worsened in 12 patients (19%), did not change in 5 (8%) and improved in 46 (73%, 95% CI 62-84); the latter proportion exceeded that reported by Flaxel (p = 0.0005, RR 1.97, 95% CI 1.25-3.1).
Discussion: although the difference was not clinically significant, the efficacy of vitreoretinal surgery to improve visual acuity in the sample was consistently higher than that reported by Flaxel in Latinos, and did not vary from other studies. These results do not support an association between an ethnic group and a lower surgical efficacy.
||best corrected visual acuity, diabetic retinopathy, vitreoretinal surgery.
Bhatnagar P, Schiff WM, Barile GR. Diabetic vitrectomy: the influence of lens status upon surgical outcomes. Curr Opin Ophthalmol 2008;19(3):243-247.
Schiff WM, Barile GR, Hwang JC, Tseng JJ, Çekiç O, Del Priore LV, et al. Diabetic Vitrectomy: Influence of Lens Status upon Anatomic and Visual Outcomes. Ophthalmology 2007;114(3):544-550.
Mattos AB, Bonomo PPO, Freitas LL, Farah ME, Flynn Jr H, Pereira MB. Facoemulsificação, vitrectomia via pars plana e implante de lente intra-ocular em olhos com retinopatia diabética proliferativa. Arq Bras Oftalmol 2004;67:441-449.
Rivas-Aguiño P, García-Amaris RA, Berrocal MH, Sánchez JG, Rivas A, Arévalo JF. Vitrectomía pars plana, facoemulsificación e implante de lente intraocular para el manejo de catarata y retinopatía diabética proliferativa: comparación de técnica quirúrgica combinada versus en dos tiempos. Arch Soc Esp Oftalmol 2009;84(1):31-38.
Avitabile T, Bonfiglio V, Castiglione F, Castaing M, Contarino F, Mistretta A. Severe proliferative diabetic retinopathy treated with vitrectomy or panretinal photocoagulation: a monocenter randomized controlled clinical trial. Can J Ophthalmol 2011;46(4):345-351.
Tao Y, Yang-Rong J, Xiao-Xin L, Lei G, Jonas J. Long-Term results of vitrectomy without endotamponade in proliferative diabetic retinopathy with tractional retinal detachment. Retina 2010;30:447- 451.
Gupta B, Sivaprasad S, Wong R, Laidlaw A, Jackson TL, McHugh D, et al. Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: The Drive UK Study. Eye 2012;26:510-516.
Yorston D, Wickham L, Benson S, Bunce C, Sheard R, Charteris D. Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol 2008;92(3):365- 368.
Song WK, Kim SS, Yi JH, Byeon SH, Koh1 HJ, Lee SC, et al. Axial length and intraoperative posterior vitreous detachment as predictive factors for surgical outcomes of diabetic vitrectomy. Eye 2010;24:1273-1278.
Flaxel C, Dustin L, Kim J, Bekendam P, Row P. Outcome of diabetic vitrectomy in Latino population. Retina 2007;27(9):1274-1278.
Scanlon PH. Why do patients still require surgery for the late complications of proliferative diabetic retinopathy? Eye 2010;24:435- 440.
Abdhish R, Bhavsar. Diabetic retinopathy: the latest in current management. Retina 2006;26:871-879.
Barría-von Bischhoffshausen F, Martínez-Castro F. Guía practica clínica de retinopatía diabética para Latinoamérica. Arlington, TX: Asociación Panamericana de Oftalmología, 2011 p. 27.
Summanen P. Significance of various systemic and ocular parameters in the long-term prognosis after diabetic vitrectomy. Int Ophthalmol 1989;13(5):311-319.
American Academy of Ophthalmology Retina Panel. Preferred Practice Pattern® Guidelines. Diabetic retinopathy. San Francisco, CA: American Academy of Ophthalmology 2008.
Asociación Mexicana de Retina, Sociedad Mexicana de Oftalmología, Asociación Panamericana de Oftalmología. Resultados del Día Panamericano de detección de retinopatía diabética (3 de julio de 1999, día “D”). Rev Mex Oftalmol 2005;79:88-92.
Cheung N, Mitchell P, Wong T. Diabetic retinopathy. Lancet 2010;376:124-136.
Varma R, Torres M, Peña F, Klein R, Azen SP, Los Angeles Latino Eye Study Group. Prevalence of diabetic retinopathy in adult Latinos: the Los Angeles Latino Eye Study. Ophthalmology 2004;111:1298- 1306.
Klein R, Klein B. Are individuals with diabetes seeing better? A Long-Term Epidemiological Perspective. Diabetes 2010;59:1853- 1860.
Gupta B, Wong B, Sivaprasad S, Williamson TH. Surgical and visual outcome following 20-gauge vitrectomy in proliferative diabetic retinopathy over a 10-year period, evidence for change in practice. Eye 2012;26:576-582.
>Cirugía y Cirujanos
>Year 2012, Issue 6