Modified Transcleral 23G Bimanual Vitrectomy in Severe Proliferative Diabetic Cases

Neelam Atri

Objective: Modified Transcleral 23G Bimanual Vitrectomy in Severe Proliferative Diabetic Cases

Purpose: Outcome of modified trans-scleral 23-Gauge bimanual vitrectomy in severe proliferative diabetic cases

Method: Retrospective interventional study of 63 diabetic eyes with macular TRD (21), extramacular TRD (31), combined TRD (9) and thick posterior hyaloid membrane (2). Pre and post-operative best corrected vision and lens status were documented.

Modifications in study are 1) Transcleral placement of 23G cannula 2) Twin torpedo lights – 12 and 6 o'clock position giving shadowless illumination, 3) Combination of non contact wide angle system and contact lens ( Lander's Ring) gives both perspective and precision 4) Suturing of sclerotomies.

Results: The mean pre and post operative logMAR best corrected visual acuity (BCVA) was 1.79 ± 0.75 and 0.96 ± 0.83 respectively. Overall vision improved in 45 eyes (71.4%), stable 13 (20.6%) eyes and worse 5 (7.9%). Pre-operatively 14 eyes (22.2%) had best corrected visual acuity ≥20/200 while post operatively 42 (66.6%) were ≥20/200 (p<.001). Pre operatively 1 eye (1.6%) had BCVA≥ 20/40, post operatively 21 eyes (33.3%) achieved ≥ 20/40 (p<.001).

30 eyes underwent simultaneous cataract extraction. C3F8 used (31) SF6 (9), silicon oil (8). Pre-operatively Avastin given in 6. Complications seen were retinal detachment 2 (3.1%) and re-bleed in 7 (11.1%).

Conclusion: Modified 23G Transcleral approach enhances performance of complete base excision and relief of peripheral traction, decreasing chances of recurrent bleeds, retinal detachment and anterior hyaloid fibrovascular proliferation. Twin torpedo lights enable better bimanual dissection. Suturing of sclerotomies avoids hypotony in these complex cases.