TY - JOUR
T1 - TRActional DIabetic reTInal detachment surgery with co-adjuvant intravitreal dexamethasONe implant
T2 - the TRADITION STUDY
AU - Iglicki, Matias
AU - Zur, Dinah
AU - Fung, Adrian
AU - Gabrielle, Pierre Henry
AU - Lupidi, Marco
AU - Santos, Rodrigo
AU - Busch, Catharina
AU - Rehak, Matus
AU - Cebeci, Zafer
AU - Charles, Martin
AU - Masarwa, Dua
AU - Schwarz, Shulamit
AU - Barak, Adiel
AU - Loewenstein, Anat
AU - for the International Retina Group (IRG)
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Aim: Main failure of diabetic tractional retinal detachment (TRD) surgery is the development of proliferative vitreoretinopathy (PVR), causing higher re-detachment rates. We investigated whether the use of dexamethasone (DEX) implant at the end of pars plana vitrectomy (PPV) with silicone oil tamponade might have an impact on these outcomes. Design: Comparative, nonrandomized, retrospective study. Participants: A total of 148 eyes from 148 patients that underwent PPV with silicone oil tamponade for diabetic TRD (with DEX implant, n = 52; without DEX implant, n = 96). Methods: Consecutive patients’ records were reviewed for time between TRD diagnosis and surgery; lens status before surgery and after 6, 12, and 24 months; retina attachment rate after primary PPV; change in postoperative PVR severity; rate of re-detachment at 6, 12, and 24 months; use of IOP lowering treatment after 6, 12, and 24 months; surgery details; intra- and postoperative complications. Correlations between outcome measures, postoperative PVR severity, and re-detachment rates were analyzed. Main outcome measures: Change in postoperative PVR severity and retinal re-detachment rates with and without the adjuvant use of DEX implant. Results: Retinal re-detachment rates were significantly higher in the group of patients that did not receive DEX implant [11/96 (11.5%) vs. 0/52 (0%), p = 0.049; 11/84 (12.9%) vs. 4/52 (7.7%), p = 0.007; 14/71 (19.7%) vs. 5/52 (10%) p < 0.001 at 6, 12, and 24 months, respectively]. PVR severity correlated with retinal status at 12 and 24 months (p = 0.018 and p = 0.027, respectively). The difference in PVR severity between the two groups was statistically significant at 6, 12, and 24 months (p < 0.001). Conclusions: DEX implant at the end of PPV in patients with diabetic TRD improves PVR severity and decreases re-detachment rates. This should be considered as an option in the customized treatment of TRD.
AB - Aim: Main failure of diabetic tractional retinal detachment (TRD) surgery is the development of proliferative vitreoretinopathy (PVR), causing higher re-detachment rates. We investigated whether the use of dexamethasone (DEX) implant at the end of pars plana vitrectomy (PPV) with silicone oil tamponade might have an impact on these outcomes. Design: Comparative, nonrandomized, retrospective study. Participants: A total of 148 eyes from 148 patients that underwent PPV with silicone oil tamponade for diabetic TRD (with DEX implant, n = 52; without DEX implant, n = 96). Methods: Consecutive patients’ records were reviewed for time between TRD diagnosis and surgery; lens status before surgery and after 6, 12, and 24 months; retina attachment rate after primary PPV; change in postoperative PVR severity; rate of re-detachment at 6, 12, and 24 months; use of IOP lowering treatment after 6, 12, and 24 months; surgery details; intra- and postoperative complications. Correlations between outcome measures, postoperative PVR severity, and re-detachment rates were analyzed. Main outcome measures: Change in postoperative PVR severity and retinal re-detachment rates with and without the adjuvant use of DEX implant. Results: Retinal re-detachment rates were significantly higher in the group of patients that did not receive DEX implant [11/96 (11.5%) vs. 0/52 (0%), p = 0.049; 11/84 (12.9%) vs. 4/52 (7.7%), p = 0.007; 14/71 (19.7%) vs. 5/52 (10%) p < 0.001 at 6, 12, and 24 months, respectively]. PVR severity correlated with retinal status at 12 and 24 months (p = 0.018 and p = 0.027, respectively). The difference in PVR severity between the two groups was statistically significant at 6, 12, and 24 months (p < 0.001). Conclusions: DEX implant at the end of PPV in patients with diabetic TRD improves PVR severity and decreases re-detachment rates. This should be considered as an option in the customized treatment of TRD.
KW - Pars plana vitrectomy for complex retinal detachment
KW - Pars plana vitrectomy for diabetic retinopathy
KW - Pars plana vitrectomy with silicone oil
KW - Steroid
KW - Traction retinal detachment
UR - http://www.scopus.com/inward/record.url?scp=85065974111&partnerID=8YFLogxK
U2 - 10.1007/s00592-019-01357-y
DO - 10.1007/s00592-019-01357-y
M3 - Article
C2 - 31089929
AN - SCOPUS:85065974111
VL - 56
SP - 1141
EP - 1147
JO - Acta Diabetologica
JF - Acta Diabetologica
SN - 0940-5429
IS - 10
ER -