Reoperation following diabetic vitrectomy
G. C. Brown, W. S. Tasman, W. E. Benson, J. A. McNamara and R. C. Eagle Jr
Retina Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa.
A review of 484 consecutive eyes that were undergoing an initial pars plana
vitrectomy for the sequelae of proliferative diabetic retinopathy disclosed
that 41 eyes (8.5%) required one or more additional vitrectomy operations.
The primary causes for reoperation included rhegmatogenous retinal
detachment in 18 (44%) of the 41 eyes, recurrent vitreous hemorrhage in 21
eyes (51%), and glaucoma in two eyes (5%). The visual prognosis was worse
in the group with rhegmatogenous retinal detachment, with 10 (56%) of 18
eyes progressing to no light perception (P = .003). Severe preretinal and
subretinal fibrous proliferation, as demonstrated histopathologically,
accounted in large part for the poor result. The preretinal membrane
formation appeared to occur secondary to a combination of diabetic
extraretinal vascular growth and proliferative vitreoretinopathy. Among the
total group of 41 eyes that required subsequent surgery, the retina
eventually remained detached in 18 eyes (44%), and phthisis bulbi occurred
in 13 eyes (32%). Rubeosis iridis developed in 17 (94%) of 18 eyes in which
the retina remained detached.
