Venkatesh Ramesh, Parmar Yash, Mangla Rubble, Sharief Shama, Yadav Naresh Kumar, Chhablani Jay
Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA.
Int J Retina Vitreous. 2023 Feb 1;9(1):7. doi: 10.1186/s40942-023-00444-1.
To report a series of cases of post-operative new secondary retinal breaks following vitrectomy for proliferative diabetic retinopathy (PDR).
This retrospective case series included data of patients diagnosed with post-operative retinal breaks following uneventful vitrectomy surgery for PDR from January 2018 to December 2021.
New post-vitrectomy retinal breaks in PDR were seen in 7% of eyes (n = 10/148 eyes; 10 patients). Age of study patients ranged from 45 to 69 years and there were 8 males. Vitreous surgery was performed for vitreous hemorrhage in six eyes, macular tractional retinal detachment in three eyes and epiretinal membrane in one eye. Tractional fibrovascular proliferation near the retinal break prior to its development was noted either pre- or intra-operatively in 8 eyes. Mean time interval between the vitreous surgery and secondary retinal break development was 6.4 months. Residual fibrous tissue post-surgery adjacent to the break was noted in 4 cases. Sclerosed retinal vessel was noted in 4 eyes and associated inner retinal thinning or schisis in 5 eyes. No retinal detachment was noted in any case. Prophylactic barrage was done in 4 eyes. Last follow-up interval ranged from 4 to 53 months and visual acuity ranged from 6/6 to 6/60. No subretinal fluid, traction or break enlargement was noted at the last visit.
Delayed post-operative retinal breaks following vitrectomy are uncommon in PDR eyes. Careful preoperative evaluation of the retinal proliferations, intraoperative dissection of the membranes and regular post-operative reviews are vital in anticipating the development of delayed post-vitrectomy retinal breaks. Observation could be the management strategy for these breaks.
报告一系列增殖性糖尿病视网膜病变（PDR）玻璃体切除术后新出现的继发性视网膜裂孔病例。
本回顾性病例系列纳入了2018年1月至2021年12月期间因PDR接受玻璃体切除术后诊断为视网膜裂孔的患者数据。
PDR患者玻璃体切除术后新出现的视网膜裂孔在7%的眼中出现（n = 10/148眼；10例患者）。研究患者年龄在45至69岁之间，男性8例。6只眼因玻璃体积血行玻璃体手术，3只眼因黄斑牵拉性视网膜脱离，1只眼因视网膜前膜。8只眼在视网膜裂孔形成前或术中发现裂孔附近有牵拉性纤维血管增殖。玻璃体手术与继发性视网膜裂孔形成的平均时间间隔为6.4个月。4例在裂孔旁发现术后残留纤维组织。4只眼可见视网膜血管硬化，5只眼伴有视网膜内层变薄或劈裂。所有病例均未发现视网膜脱离。4只眼进行了预防性光凝。末次随访时间间隔为4至53个月，视力范围为6/6至6/60。末次随访时未发现视网膜下液、牵拉或裂孔扩大。
玻璃体切除术后延迟出现的视网膜裂孔在PDR眼中并不常见。术前仔细评估视网膜增殖情况、术中仔细分离膜以及定期术后复查对于预测玻璃体切除术后延迟性视网膜裂孔的发生至关重要。观察可能是这些裂孔的处理策略。
