Predictors and Outcomes of Vitrectomy and Silicone Oil Injection in Advanced Diabetic Retinopathy

PURPOSE: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR). METHODS: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate. RESULTS: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. CONCLUSIONS: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.

Analgesic Effect of Topical Sodium Diclofenac before Retinal Photocoagulation for Diabetic Retinopathy: A Randomized Double-masked Placebo-controlled Intraindividual Crossover Clinical Trial

PURPOSE: To evaluate the analgesic effect of topical sodium diclofenac 0.1% before retinal laser photocoagulation for diabetic retinopathy. METHODS: Diabetic patients who were candidates for peripheral laser photocoagulation were included in a randomized, placebo-controlled, intraindividual, two-period, and crossover clinical trial. At the first session and based on randomization, one eye received topical sodium diclofenac 0.1% and the other eye received an artificial tear drop (as placebo) three times before laser treatment. At the second session, eyes were given the alternate drug. Patients scored their pain using visual analogue scale (max, 10 cm) at both sessions. Patients and the surgeon were blinded to the drops given. Difference of pain level was the main outcome measure. RESULTS: A total of 200 eyes of 100 patients were enrolled. Both treatments were matched regarding the applied laser. Pain sensation based on visual analogue scale was 5.6 ± 3.0 in the treated group and 5.5 ± 3.0 in the control group. The calculated treatment effect was 0.15 (95% confidence interval, −0.27 to 0.58; p = 0.486). The estimated period effect was 0.24 (p = 0.530) and the carryover effect was not significant (p = 0.283). CONCLUSIONS: Pretreatment with topical sodium diclofenac 0.1% does not have any analgesic effect during peripheral retinal laser photocoagulation in diabetic patients.

Astigmatic outcomes of temporal versus nasal clear corneal phacoemulsification

To compare the astigmatic outcomes of phacoemulsification cataract surgery using temporal versus nasal clear corneal incisions. In a clinical trial, consecutive patients with senile cataracts underwent phacoemulsification and implantation of a hydrophobic acrylic foldable intraocular lens through a horizontal clear corneal incision [temporal in right and nasal in left eyes]. Outcome measures included keratometric astigmatism and surgically induced astigmatism [SIA] calculated by the vector analysis method using the Holladay-Cravy-Koch formula. The nasal and temporal groups consisted of 20 eyes each. Mean preoperative keratometric astigmatism was 0.63 +/- 0.48 D and 0.38 +/- 0.39 D in the temporal and nasal incision groups respectively [P=0.09]. Data on 10 eyes in each study group was available for the six-month analysis. Mean keratometric astigmatism was as follows in the temporal and nasal groups respectively: 0.85 +/- 0.47 D versus 1.95 +/- 0.45 D at 1 week [P < 0.001], 0.73 +/- 0.46 D versus 1.79 +/- 0.55 D at 4 weeks [P < 0.001], and 0.63_0.30 D versus 1.05 +/- 0.56 D at 6 months [P = 0.053] after surgery. SIA at the same follow-up intervals was 0.71 +/- 0.20 D versus 1.80 +/- 0.22 D [P < 0.001], 0.63 +/- 0.20 D versus 1.65 +/- 0.31 D [P < 0.001] and 0.26 +/- 0.46 D versus 0.92 +/- 0.36 D [P=0.002] in the temporal versus nasal incision groups respectively. Temporal clear corneal phacoemulsification induces significantly less astigmatism as compared to similar surgery using the nasal approach