[Should associated intraoperative and/or postoperative photocoagulation be systematic during or after vitrectomy for proliferative diabetic vitreoretinopathy?].
OBJECTIVE
To analyze the results of vitrectomy in proliferative diabetic vitreoretinopathy and to check whether systematic intra- and/or postoperative photocoagulation is necessary in most cases.


METHODS
We retrospectively reviewed 108 patient records (137 eyes) of vitrectomy performed for complications of proliferative diabetic vitreoretinopathy between 1982 and 2000. Fifty-eight percent of the patients were women. The average age was 44 years. Sixty percent of the patients presented with diabetes type 1. Only 39% of the eyes had complete preoperative panretinal photocoagulation. Preoperative visual acuity was lower than 2/200 in 81% of eyes, 27% presenting initially with traction retinal detachment involving the macula. The surgical technique used was segmentation-delamination. Endodiathermy was necessary in 45% of the eyes and intraoperative photocoagulation was not performed. Postoperative complementary photocoagulation was carried out in only 9% of the eyes.


RESULTS
Results were analyzed with an average follow-up of 66 months. Anatomical success was obtained in 69% of the eyes, with 55% visual improvement. These results were unchanging at long-term follow-up in 95% of the eyes studied. Iatrogenic retinal breaks were observed in 8% of the eyes. Postoperative complications were dominated by single (8%) or recurrent vitreous hemorrhage (8%). The rate of postoperative neovascular glaucoma was approximately 5%. These results are similar to the rates reported by other authors using intraoperative endophotocoagulation.


CONCLUSIONS
Intra- and/or postoperative photocoagulation should not be systematic but reserved for management of iatrogenic retinal breaks and also for extensive panretinal photocoagulation in recurrent vitreous hemorrhage.
Hajji
Z
Z
Clinique Universitaire Ophtalmologique B, CHU Rabat-Salé, Maroc.
Rouillot
J-S
JS
Roth
P
P
Grange
J-D
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000601:surgery*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008028:Light Coagulation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity; D014821:Vitrectomy; D018630:Vitreoretinopathy, Proliferative / Q000601:surgery*