Proliferative Diabetic Retinopathy Clinical Trial
Official title:
Macular Hole After Diabetic Vitrectomy
To present the clinical characteristics and rational treatment of macular hole (MH) after the diabetic vitrectomy (DV) in patients with proliferative diabetic retinopathy (PDR).
All patients had received initial vitrectomy to treat complications of PDR. Recruited
patients were divided to two groups: the persistent MH group, who had MH before the primary
DV (group 1); and the newly-developed MH group, who developed MH after a successful primary
DV (group 2). The patients' demographic data, records of ophthalmological examinations, and
surgical procedures were collected, including best-corrected visual acuity before and after
each operation, fundus changes, as well as MH repairing techniques. The extent of
fibrovascular proliferation(FVP) was separated into four grades based on the severity of
vitreoretinal adhesion : multiple-point adhesions with or without one site plaque-like broad
adhesion (grade 1), broad adhesions in more than one but fewer than three sites, located
posterior to the equator (grade 2), broad adhesions in more than three sites, located
posterior to the equator or extending beyond the equator within one quadrant (grade 3), and
broad adhesions extending beyond the equator for more than one quadrant (grade 4). The extent
of retinal detachment (RD) was classified into "within the arcade" or "beyond the arcade".
The macular structure was evaluated by optical coherence tomography (OCT). All patients had a
follow-up duration of more than three months after the final surgical procedures.
Three different surgical techniques were used to treat MH: standard internal limiting
membrane (ILM) peeling, inverted ILM flap insertion into the MH, and lens anterior or
posterior capsular flap insertion into the MH. The indication(s) for each technique were:
standard ILM peeling was performed if no ILM peeling had been done in the previous surgery,
and the MH size was less than 500um in an attached retina; inverted ILM flap insertion was
performed if no ILM peeling had been done in the previous surgery, with a detached retina;
lens anterior capsule flap insertion was performed if cataract surgery was performed in the
same setting with no ILM tissue available; lens posterior capsule flap insertion was
performed in a pseudophakic eye with no ILM tissue available. Only descriptive statistics was
obtained.
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