Trimanual Versus Unimanual 23-Gauge Vitrectomy in Patients With Diabetes: Limitations and Expectations.

BACKGROUND AND OBJECTIVE: To compare between trimanual and unimanual vitrectomy in complicated proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: A prospective, non-randomized, comparative study including patients with tractional retinal detachment (TRD), vitreous hemorrhage with TRD, and combined TRD with rhegmatogenous retinal detachment. The patients were allocated into two groups: the unimanual group with three-port vitrectomy and the trimanual group with added fourth sclerotomy, through which the endoillumination probe was guided by the assistant. The primary outcomes included the intraoperative feasibility, operative time, and complications. RESULTS: Eighty-two eyes were categorized into the two groups: 44 eyes in the unimanual group and 38 eyes in the trimanual group. Operative time was significantly shorter in the trimanual group (P < .005). The incidence of iatrogenic breaks and intraoperative bleeding was significantly higher in the unimanual group (P = .034 and P = .044, respectively). Primary anatomic success was achieved in 90.9% and 94.7% in unimanual and trimanual groups, respectively, without significant difference (P = .411). There was no significant difference in the postoperative complications. CONCLUSIONS: Trimanual vitrectomy was proven to be a safe and effective technique in managing complicated PDR. It results in anatomical outcomes comparable to standard unimanual vitrectomy with fewer intraoperative complications. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:42-49.].

Soloist performance of vitrectomy probe in proliferative diabetic retinopathy.

PURPOSE:: To evaluate the feasibility and outcomes of the sole use of 23g pars plana vitrectomy in cases with diabetic vitreous hemorrhage with vitreoretinal traction. METHODS:: Prospective interventional case series involving patients between January 2013 and January 2018. All eyes underwent 23g pars plana vitrectomy with internal tamponade. Intraoperative parameters including ancillary instruments, the methods used for hemostasis and complications were all recorded. Postoperative parameters including anatomic success rate, functional success, and postoperative complications were recorded and analyzed. Patients were followed up for at least 12 months. RESULTS:: A total of 68 eyes of 66 patients were included. Intraoperative ancillary instruments were required in 5 (7.4%) eyes. None of the cases required the use of chandelier illumination, endodiathermy, or scissors. Mean best-corrected visual acuity improved significantly from LogMAR 1.67 ± 0.63 preoperative to 1.22 ± 0.38 at 1-year follow-up (P = 0.005). Functional success was achieved in 37 (54.4%) eyes at 1-year follow-up. Iatrogenic breaks occurred in 3 (4.4%) eyes, vitreous hemorrhage in 4 (5.9%) eyes, and epiretinal membranes in 3 (4.4%) eyes. Repeated vitrectomy was done in 3 (4.4%) eyes. CONCLUSION:: The 23g vitrectomy probe proved to be a safe, effective, and beneficial single tool that could accomplish the diabetic vitrectomy mission exclusively with minimal aid from other instruments in cases with vitreous hemorrhage associated with vitreoretinal traction.