PURPOSE: The author evaluated the impact of vitreoretinal surgery for proliferative diabetic retinopathy (PDR) on bilateral visual function. METHODS: Anatomic and visual acuity outcomes were reviewed by author for patients who underwent bilateral surgery for PDR. Bilateral visual function was evaluated using the American Medical Association (AMA) Guidelines for Disability scale to quantitate the impact of surgery on visual system disability. RESULTS: There were 18 patients (36 eyes) who underwent vitrectomy for complications of PDR, and the overall anatomic success rate was 100%. Mean visual impairment of the study eyes and visual system according to AMA Guidelines for Disability decreased postoperatively by 22.4% points, and 25.7% points, respectively. A higher functional level of the bilateral visual system resulted postoperatively in 83.2% of all patients, according to eyes with better visual acuity. CONCLUSIONS: Vitreoretinal surgery was associated with a reduction in bilateral visual disability and improved bilateral visual function in patients with PDR.
American Medical Association ; Diabetic Retinopathy* ; Humans ; Vision Disorders ; Visual Acuity ; Vitrectomy* ; Vitreoretinal Surgery

PURPOSE: To verify the clinical correlation between retinopathy progression and the change of venous filling time (VFT), measured before and after panretinal photocoagulation (PRP), in proliferative diabetic retinopathy (PDR) patients. METHODS: We conducted this study on 32 patients (32 eyes) who received PRP for PDR. These patients were subdivided into two groups in accordance with the clinical course of PRP: the stabilized group in which retinal neovascularization was regressed and the progressed group in which retinal neovascularization was continued and a complication, such as vitreous hemorrhage or tractional retinal detachment, was developed within 12 months of laser treatment. Arteriovenous passage time (AVP) and VFT were measured by video fluorescein angiogram (FAG) using scanning laser ophthalmoscope (SLO) before and after PRP. VFT values were assigned by measuring by the time duration from start of venous lamina flow to the fullness of fluorescence on the vascular arch. RESULTS: In the stabilized group, AVP was decreased by 0.20+/-0.89sec and VFT was decreased by 0.30+/-1.69 sec through PRP. In the progressed group, AVP was increased in 0.12+/-1.22 sec and VFT was increased by 0.99+/-1.60 sec through PRP. In both groups, the VFT changes were significant (P=0.04) but the AVP changes were not (P=0.34). CONCLUSIONS: VFT was significantly decreased in the stabilized group and significantly increased in the progressed group after PRP. Accordingly, we suggest that VFT changes after PRP can be utilized as a prognostic indicator for evaluating clinical course of diabetic retinopathy after performing PRP and for monitoring the clinical effect of PRP.
Veins ; Time Factors ; Retinal Vessels/*physiopathology ; Regional Blood Flow ; *Light Coagulation ; Humans ; Diabetic Retinopathy/*physiopathology/*surgery

Aged ; Diabetic Retinopathy ; physiopathology ; surgery ; Electroretinography ; Female ; Humans ; Macular Edema ; physiopathology ; surgery ; Male ; Middle Aged ; Retina ; physiopathology ; Visual Acuity ; Vitrectomy

To analyse the results of diabetic vitrectomy according to the severity of proliferation [severe (SPG) vs. less-severe proliferation group (LSPG)], and methods of the operation, which was complete removal of anteroposterior vitreous traction with or without complete removal of preretinal memebrane, we compared both groups by using anatomic success rate and postoperative visual acuities (VA). The results were as follows: The anatomic success rate and postoperative VA were significantly better in LSPG than in SPG. In SPG, anatomic success rate and postoperative VA tended to be better when complete removal of anteroposterior traction was possible than when impossible. In SPG, postoperative VA tended to be better when complete removal of preretinal membrane was possible, but the anatomic success rate was the same for each group. So, when severe proliferation (including table-top elevation of posterior retina), complete removal of anteroposterior traction only can improve the anatomic success rate of the surgery.
Adult ; Aged ; Cell Membrane ; Diabetic Retinopathy/physiopathology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Visual Acuity/physiology ; Vitrectomy/*methods

Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.
Bariatric Surgery* ; Diabetes Mellitus ; Diabetic Retinopathy* ; Hemoglobin A, Glycosylated ; Hyperglycemia ; Hypoglycemia ; Life Style ; Obesity ; Population Characteristics ; Retinaldehyde ; Risk Factors

BACKGROUND: Neovascular glaucoma is common secondary glaucoma at high risk for failure of glaucoma filtering surgery. Recently, trabeculectomy with adjunctive mitomycin C trabeculectomy has been tried to improve the surgical success rate of conventional trabeculectomy. But, the long-term effects of mitomycin C trabeculectomy for neovascular glaucoma are unknown. Thus, we evaluated the long-term effects of mitomycin C trabeculectomy and its prognostic factors influencing the outcome. MATERIALS AND METHODS: Medical records of 62 eyes of 55 neovascular glaucoma who had undergone mitomycin C trabeculectomy were retrospectively reviewed. Surgical success was defined as intraocular pressures of 21 mmHg or less with or without glaucoma medications and no loss of light perception. Surgical failure was defined as postoperative loss of light perception in patients with preoperative vision better than light perception, additional glaucoma surgery, or phthisis bulbi in patients with preoperative vision of no light perception. RESULTS: Postoperative success was obtained in 37 (60%) out of 62 eyes after mean follow- up period of 23.9+/-16.2 months. Using Kaplan-Meier survival analysis, cumulative success rate at the 6-, 12-, 24- and 36-month intervals were 85%, 71%, 57% and 52%, respectively. Success rate was greater in eyes with diabetic retinopathy than other causes(p=0.005) and in eyes with preoperative panretinal photocoagulation(PRP) than without PRP(p=0.015). However, Cox proportional hazard regression analysis revealed that preoperative PRP was not a significant risk factor for surgical failure. CONCLUSION: Prognosis of neovascular glaucoma caused by diabetic retinopathy was better than that caused by the other disorders following mitomycin C trabeculectomy. The author would suggest that mitomycin C trabeculectomy could be effective and relatively safe as the first procedure of choice before performing glaucoma drainage device implantation or cyclodestructive procedure.
Diabetic Retinopathy ; Drainage ; Filtering Surgery ; Glaucoma ; Glaucoma, Neovascular* ; Humans ; Intraocular Pressure ; Medical Records ; Mitomycin* ; Prognosis ; Retrospective Studies ; Risk Factors ; Trabeculectomy*

OBJECTIVETo examine the prognosis of preretinal hemorrhage following vitrectomy and silicone oil tamponade for severe proliferative diabetic retinopathy.

METHODSClinical data of 76 cases of proliferative diabetic retinopathy treated with vitrectomy and silicone oil infusion tamponade in Sir Run Run Shaw Hospital from October 2006 to September 2013 were retrospectively reviewed. Intraoperative bleeding,postoperative preretinal bleeding,blood reabsorption time, and preretinal fibrosis were assessed.

RESULTSAll preretinal hemorrhage developed within 1 week after surgery, blood was distributed in thin and scattered patterns (32 cases), thick and localized patterns (25 cases) or thick and scattered patterns (19 cases). The preretinal hemorrhage was ceased in 1 day after operation in 35 cases, in 2 days after operation in 18 cases, in two weeks after operation in 23 case. Recurrent hemorrhage occurred within 1 week after operation in 15 cases. Thin blood was largely reabsorbed in about two weeks, and thick blood was largely reabsorbed in about five weeks. Fibrosis tissue was resulted in 15 cases(34.1%) with thick blood.

CONCLUSIONMost of preretinal hemorrhage occurs within 1 week after surgery and is reabsorpted with 5 weeks in patients with proliferative diabetic retinopathy undergoing vitrectomy and silicone oil tamponade. The major complication of preretinal bleeding is the formation of preretinal fibrosis.

Diabetic Retinopathy ; surgery ; Fibrosis ; Humans ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Silicone Oils ; therapeutic use ; Vitrectomy ; Vitreous Hemorrhage ; epidemiology

Diabetic Retinopathy ; complications ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retinal Vein Occlusion ; complications ; Vitrectomy ; Vitreous Hemorrhage ; etiology ; surgery

We performed a retrospective study of serum factors associated with neovascular glaucoma that can occur following vitrectomy for proliferative diabetic retinopathy. The medical records of 183 patients (241 eyes) who received vitrectomy between August 1996 and August 2000 were studied retrospectively and subsequently analyzed by linear logistic regression analysis and multiple logistic regression tests. Neovascular glaucoma developed at an average of 2.7 months in 31 of 241 eyes (14.1%). The overall anatomical success rate of retinal attachment was 82.5% (199 eyes in 241 eyes), although it decreased to 45.1% (14 eyes in 31 eyes) in eyes with neovascular glaucoma. Serum cholesterol (P = 0.041) and fibrinogen levels (P = 0.020) were significantly associated with the development of neovascular glaucoma. However, no significant association could be found concerning hypertension, diabetic retinopathy or hypercholesterolemia (P > 0.05). We suggest that serum creatinine, cholesterol and fibrinogen levels can be used to predict the development of neovascular glaucoma in vitrectomized eyes with diabetic retinopathy and can further provide a more active approach to preventing the development of this condition.
Adult ; Aged ; Aged, 80 and over ; Blood/metabolism ; Cell Division ; Diabetic Retinopathy/*pathology/*surgery ; Glaucoma, Neovascular/*blood/*complications ; Human ; Middle Age ; Postoperative Period ; Retrospective Studies ; *Vitrectomy

PURPOSE: Combined with vitreoretinal surgery, silicone oil endotamponade has become a standard technique and improved the prognosis of complex retinal diseases. To improve success rate of silicone oil endotamponade, the authors analysed complications and associated with other variables. METHODS: The authors analysed 90 cases of silicone oil endotamponade (102 eyes), all operated by one surgeon from 1995 to 2000 and followed-up over 6 months. The series consisted of proliferative diabetic retinopathy (48 eyes), complex retinal detachment (33 eyes), proliferative vitreoretinpathy (11 eyes) and ocular trauma (10 eyes). Analysed variables were preoperative visual acuity, rubeosis iridis, nuber of operations, duration of tamponade, emulsification of silicone oil, lentile status, anterior proliferative vitreoretinpathy, keratopathy, change of ocular tension, redetachment, macular degeneration and electroretinogram. RESULTS: Anatomic success was achieved in 95 of 102 eyes (93.1%) and functional success was achieved in 66 eyes (64.7%). Change of ocular tension over 10mmHg, anterior proliferative vitreoretinpathy and anatomical failure were statistically significant prognostic factors. CONCLUSIONS: Silicone oil endotamponade is an effective measure for complex retinal diseases, but its complication has always been an issue. If these complications can well be kept under the control, silicone oil endotamponade will become more widely used surgical modality.
Diabetic Retinopathy ; Endotamponade* ; Intraocular Pressure ; Lens Plant ; Macular Degeneration ; Prognosis ; Retinal Detachment ; Retinal Diseases ; Silicone Oils* ; Visual Acuity ; Vitrectomy ; Vitreoretinal Surgery