Prognostic factors in Pars Plana vitrectomy for Proliferative Diabetic Retinopathy

  • Dr. Keerthivarman Rukmangathan Associate Professor, Department of Ophthalmology, Annapoorana Medical College, Salem. Tamil Nadu, India
  • Dr. P. Nandhakishore Consultant, Aravind Eye Hospital, Theni, Tamil Nadu, India
  • Dr. Ramusiddharthan Ravichandran Consultant, Sri Ramanamaharishi Eye Hospital, Thiruvannamalai, Tamil Nadu, India
  • Dr. Ranjan Chandrasekaran Consultant, Annai Eye Hospital, Ramanathapuram, Tamil Nadu, India
Keywords: Proliferative diabetic retinopathy, Pars plana vitrectomy, Non-proliferative diabetic retinopathy


Objective: To determine the factors associated with good visual outcome in eyes undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Furthermore, the objective of the study was to compare the clinical outcome and complications of standard 20 gauge vitrectomy with 23-gauge transconjunctival sutureless vitrectomy.

Materials and Methods: This was a prospective interventional study performed on patients presenting at the Retina clinic of a tertiary eye care hospital in Salem, Tamil Nadu between October 2018 to November 2019. All eyes undergoing PPV for complications of PDR and having adequate follow were included. The patients were divided into two groups, one group undergoing standard 20 gauge vitrectomy and the other group undergoing 23 gauge transconjunctival sutureless vitrectomy.

Results: A total of Forty-nine eyes (25 eyes underwent standard 20 gauge vitrectomy and 24 eyes underwent 23 gauge transconjunctival sutureless vitrectomy). Visual acuity improved significantly following PPV (p<0.0001) and this improvement was seen in both 20 gauge group (p=0.0004) and in 23 gauge group (p=0.00005). There was no significant difference in best-corrected visual acuity noted between the two groups. However, eyes that underwent 23 gauge vitrectomy tended to gain vision earlier when compared to eyes that underwent 20 gauge vitrectomy. Complications following vitrectomy did not differ significantly between 20 gauge and 23 gauge group.

Conclusion: Visual acuity improved significantly following PPV across all indications. Visual acuity in eyes that underwent 23 gauge TSV tended to gain vision earlier than eyes that underwent standard 20 gauge vitrectomy.


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Diabetes Atlas. International diabetes foundation. Brussels, Belgium, 2nd ed,2003 Chapter 7,7. South-east Asia, pp 255-259.

Klein R, Klein B, Moss S, Davis M, DeMets D. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmol. 1984;91(12):1464-1474. doi: 10.1016/s0161-6420(84)34102-1.

Aiello L. Perspectives on diabetic retinopathy. Am J Ophthalmol. 2003;136(1):122-135. doi: 10.1016/s0002-9394(03)00219-8.

Bresnick G. Diabetic Macular Edema. Ophthalmol. 1986;93(7):989-997. doi: 10.1016/s0161-6420(86)33650-9.

Progression of Retinopathy with Intensive versus Conventional Treatment in the Diabetes Control and Complications Trial. Ophthalmol. 1995;102(4):647-661. doi: 10.1016/s0161-6420(95)30973-6.

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet. 1998;352(9131):837-853.

UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317(7160):703-713.

Smiddy W, Flynn H. Vitrectomy in the Management of Diabetic Retinopathy. Surv Ophthalmol. 1999;43(6):491-507. doi: 10.1016/s0039-6257(99)00036-3.

Oyakawa R, Schachat A, Michels R, Rice T. Complications of Vitreous Surgery for Diabetic Retinopathy. Ophthalmol. 1983;90(5):517-521. doi: 10.1016/S0161-6420(83)34540-1.

Blankenship G, Cortez R, Machemer R. The lens and pars plana vitrectomy for diabetic retinopathy complications. Arch Ophthalmol. 1979;97(7):1263-1267. doi: 10.1001/archopht.1979.01020020005001.

Honavar S, Goyal M, Majji A, Sen P, Naduvilath T, Dandona L. Glaucoma after pars plana vitrectomy and silicone oil injection for complicated retinal detachments. Ophthalmol. 1999;106(1):169-177. doi: 10.1016/S0161-6420(99)90017-9.

Chen J. Sutureless Pars Plana Vitrectomy Through Self-sealing Sclerotomies. Arch Ophthalmol. 1996;114(10):1273. doi: 10.1001/archopht.1996.01100140473024.

Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005;25(2):208-211. doi: 10.1097/00006982-200502000-00015.

Early Vitrectomy for Severe Vitreous Hemorrhage in Diabetic Retinopathy. Arch Ophthalmol. 1985;103(11):1644.

Ferreira N, Pessoa B, Macedo M, Queirós P, Meireles A. Vitrectomy in diabetic retinopathy. European Vitreoretinal Society.

Thompson J, De Bustros S, Michels R, Rice T, Glaser B. Results of Vitrectomy for Proliferative Diabetic Retinopathy. Ophthalmol. 1986;93(12):1571-1574. doi: 10.1016/s0161-6420(86)33541-3.

Ho T, Smiddy W, Flynn H. Vitrectomy in the management of diabetic eye disease. Surv Ophthalmol. 1992;37(3):190-202. doi: 10.1016/0039-6257(92)90137-I.

Helbig H. Surgery for Diabetic Retinopathy. Ophthalmologica. 2007;221(2):103-111. doi: 10.1159/000098255.

Qamar RMR, Saleem MI, Saleem MF. The outcomes of pars plana vitrectomy without endotamponade for tractional retinal detachment secondary toproliferative diabetic retinopathy. Int J Ophthalmol. 2013;6(5):671-674. doi: 10.3980/j.issn.2222-3959.2013.05.23.

Castellarin A, Grigorian R, Bhagat N, Del Priore L, Zarbin MA. Vitrectomy with silicone oilinfusion in severe diabetic retinopathy. Br J Ophthalmol. 2003;87(3):318-321. doi: 10.1136/bjo.87.3.318.

Canan H, Sizmaz S, Altan YR. Surgical results of combined pars planavitrectomy and phacoemulsification for vitreous hemorrhage in PDR. Clin Ophthalmol. 2013;7:1597-1601. doi: 10.2147/OPTH.S47780.

Avitabile T, Bonfiglio V, Castiglione F, Castaing M, Contarino F, Mistretta A. Severe proliferative diabetic retinopathy treated with vitrectomy or panretinal photocoagulation. Can J Ophthalmol. 2011;46(4):345-351. doi: 10.1016/j.jcjo.2011.06.012.

Modarres M, Nazari H, Ghasemi Falavarjani K, Naseripour M, Hashemi M, Mehdi Parvaresh M. Intravitreal injection ofbevacizumab before vitrectomy for proliferative diabetic retinopathy. Eur J Ophthalmol. 2009;19(5):848-852. doi: 10.1177/112067210901900526.

Yeung L, Liu L, Wu WC, Kuo YH, Chao AN, Chen KJ, et al. Reducing the incidence of early postoperative vitreous hemorrhage by preoperative intravitreal bevacizumab in vitrectomy for diabetic tractional retinal detachment. Acta Ophthalmol. 2010;88(6):635-640. doi: 10.1111/j.1755-3768.2008.01498.x.

West JF, Gregor ZJ. Fibrovascular ingrowth and recurrent hemorrhage following diabetic vitrectomy. Br J Ophthalmol. 2000;84:822-825.

Park DH, Shin JP, Kim SY. Comparison of clinical outcomes between 23-gaugeand 20-gauge vitrectomy in patients with proliferative diabetic retinopathy. Retina. 2010;30(10):1662-1670. doi: 10.1097/IAE.0b013e3181d95261.

Issa SA, Connor A, Habib M, Steel DH. Comparison of retinal breaks observed during 23-gauge transconjunctival vitrectomy versus conventional 20-gauge surgery for proliferative diabetic retinopathy. Clin Ophthalmol. 2011;5:109-114. doi: 10.2147/OPTH.S16414.

Machemer R, Blankenship G. Vitrectomy for proliferative diabetic retinopathyassociated with vitreous hemorrhage. Ophthalmol. 1981;88(7):643-646. doi: 10.1016/s0161-6420(81)34972-0.

How to Cite
Dr. Keerthivarman Rukmangathan, Dr. P. Nandhakishore, Dr. Ramusiddharthan Ravichandran, & Dr. Ranjan Chandrasekaran. (2020). Prognostic factors in Pars Plana vitrectomy for Proliferative Diabetic Retinopathy. Tropical Journal of Ophthalmology and Otolaryngology, 5(6), 116-124.
Original Article