ABSTRACT
PURPOSE: To evaluate the outcomes of twenty-seven-gauge (27G) vitrectomy in cases with complex proliferative diabetic retinopathy (PDR). METHODS: This was a retrospective interventional study of eyes that underwent 27G vitrectomy for complex PDR. The demographic profile, history, examination findings, and intraoperative surgical steps (especially use of other instruments such as intravitreal scissors/forceps) were reviewed. All the eyes were followed up for a minimum of 3 months at 1-week, 1-month, and 3-month interval. Visual acuity, intraocular pressure (IOP), and retinal status were documented at every follow-up. RESULTS: Nineteen eyes of 17 patients with complex PDR were included in the study. Seven eyes had tractional retinal detachment involving the macula, three had tractional retinal detachment threatening the macula, one had secondary rhegmatogenous retinal detachment, and eight eyes had nonresolving vitreous hemorrhage along with thick fibrovascular proliferation (FVP) at posterior pole. Anatomical attachment was seen in all cases at the end of follow-up with a single surgery. Visual acuity improved from logMAR 2.5 preoperatively to logMAR 1.01 at 3 months (P = 0.0003). None of the cases required use of intravitreal scissors/forceps for the removal of FVP. Early postoperative vitreous hemorrhage was seen in two eyes. Hypotony was not seen in any eye, while increased IOP was seen in five eyes. CONCLUSION: 27G vitrectomy is a safe and effective technique in cases with complex diabetic surgery. Due to smaller size cutter, it offers advantages in the dissection of tissue and is associated with lower incidence of early postoperative hemorrhage.
ABSTRACT
PURPOSE: To compare the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) with intrascleral haptic-fixated intraocular lens (IOL) in a sequential and simultaneous approach. SETTING: Tertiary eyecare center. DESIGN: Prospective randomized comparative study. METHODS: Patients with aphakic or complicated pseudophakic bullous keratopathy visiting a tertiary eyecare center were included in the study. A total of 40 patients were randomized into 2 groups of 20 each. Group 1 had subjects who underwent scleral-fixated IOL (SF IOL) implantation by intrascleral haptic fixation technique, followed by DSAEK (sequential procedure) with an interval of at least 3 months. Group 2 (simultaneous) had subjects who underwent DSAEK with SF IOL as a combined procedure. Graft survival, endothelial cell loss (ECL), corrected distance visual acuity (CDVA), and need for any intervention such as rebubbling were evaluated for both the groups at the end of 6 months. RESULTS: At 6 months, the sequential group had significantly better CDVA of 0.62 ± 0.17 logMAR compared with 0.87 ± 0.19 logMAR in the simultaneous group (P = .002). Group 1 had significantly better overall cumulative graft survival (100% vs 60%, P = .002), significantly lower ECL (P = .006), lesser mean central corneal thickness (P = .03), and significantly thinner donor lenticule (P = .009). Rebubbling rate was significantly higher in Group 2 (P = .025). The mean hyperopic shift was significantly more in Group 2 (P = .02). CONCLUSION: The sequential procedure of SF IOL followed by DSAEK has better visual outcomes and graft survival when compared with simultaneous procedure in cases of aphakic or complicated pseudophakic bullous keratopathy.
