Incidence of Postoperative Epiretinal Membrane Development Following 23-Gauge Pars Plana Vitrectomy for Complex Diabetic Tractional Retinal Detachment: A Comparative Study of Silicone Oil and Balanced Salt Solution Tamponade

Open Access Macedonian Journal of Medical Sciences Pub Date : 2024-02-09 DOI:10.3889/oamjms.2024.11797

A. A. Kadhim, Abeer Al Shalchi, Ameer Bananzada

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引用次数: 0

Abstract

BACKGROUND: Tractional retinal detachment (TRD) poses a significant threat to vision in diabetic patients, necessitating surgical intervention. However, the choice of tamponade agent (silicone oil vs. balanced salt solution [BSS]) and the presence of incomplete hemostasis during surgery can influence postoperative complications, specifically the development of epiretinal membranes (ERMs). METHODS: This prospective study involved 235 patients undergoing 23-Gauge pars plana vitrectomy for diabetic TRD with incomplete hemostasis. Patients were categorized into two groups based on tamponade agent used. ERM development was assessed clinically and through optical coherence tomography (OCT). RESULTS: Among the cases with incomplete hemostasis and residual preretinal hemorrhage, 71.80% of those in the silicone oil group developed ERMs, in contrast to 11.76% in the BSS. Notably, 46.2% of silicone oil cases with ERMs required reoperation, whereas 47.4% remained ERM-free. DISCUSSION: The choice of tamponade agent was a crucial determinant in ERM development, with silicone oil exhibiting a significantly higher incidence. Moreover, silicone oil cases with macular tractional effects had a substantial proportion of ERMs necessitating reoperation. These findings underscore the importance of vigilant postoperative monitoring. CONCLUSION: In cases involving incomplete hemostasis during vitrectomy for diabetic TRD, the use of silicone oil as a tamponade agent is associated with a substantially increased risk of postoperative ERM development. Clinically, this highlights the need for meticulous patient management. Further research is warranted to validate these results and explore long-term outcomes.

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23号玻璃体旁切除术治疗复杂糖尿病牵拉性视网膜脱离术后视网膜外膜形成的发生率：硅油和平衡盐溶液填塞的比较研究

背景：牵张性视网膜脱离（TRD）对糖尿病患者的视力构成严重威胁，必须进行手术干预。然而，选择何种填塞剂（硅油还是平衡盐溶液[BSS]）以及手术中是否存在不完全止血会影响术后并发症，尤其是视网膜外膜（ERM）的发生。根据使用的填塞剂将患者分为两组。结果：在止血不全和残留视网膜前出血的病例中，71.80%的硅油组患者出现了 ERM，而 BSS 组只有 11.76%。值得注意的是，46.2%的硅油组 ERM 病例需要再次手术，而 47.4% 的病例则没有 ERM。讨论：填塞剂的选择是 ERM 发生的关键因素，硅油组的发生率明显更高。此外，有黄斑牵引效应的硅酮油病例中有很大一部分 ERM 需要再次手术。结论：在治疗糖尿病 TRD 的玻璃体切除术中，如果止血不彻底，使用硅酮油作为填塞剂会大大增加术后 ERM 发生的风险。在临床上，这凸显了对患者进行细致管理的必要性。有必要开展进一步研究，以验证这些结果并探讨长期疗效。

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来源期刊

Open Access Macedonian Journal of Medical Sciences Medicine-Medicine (all)

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1225

期刊介绍： Open Access Macedonian Journal of Medical Sciences (OAMJMS) [formerly known as Macedonian Journal of Medical Sciences] is a top-tier open access medical science journal published by the ID Design 2012/DOOEL Skopje, Rajko Zhinzifov No 48, 1000 Skopje, Republic of Macedonia. OAMJMS is an international, modern, general medical journal covering all areas in the medical sciences, from basic studies to large clinical trials and cost-effectiveness analyses. We publish mostly human studies that substantially enhance our understanding of disease epidemiology, etiology, and physiology; the development of prognostic and diagnostic technologies; trials that test the efficacy of specific interventions and those that compare different treatments; and systematic reviews. We aim to promote translation of basic research into clinical investigation, and of clinical evidence into practice. We publish occasional studies in animal models when they report outstanding research findings that are highly clinically relevant. Our audience is the international medical community as well as educators, policy makers, patient advocacy groups, and interested members of the public around the world. OAMJMS is published quarterly online version. The Open Access Macedonian Journal of Medical Sciences (OAMJMS) publishes Medical Informatics, Basic Science, Clinical Science, Case Report, Brief Communication, Public Health, Public Policy, and Review Article from all fields of medicine and related fields. This journal also publishes, continuously or occasionally, the bibliographies of the members of the Society, medical history, medical publications, thesis abstracts, book reviews, reports on meetings, information on future meetings, important events and dates, and various headings which contribute to the development of the corresponding scientific field.