Abstract
AIM: To assess the application of an ophthalmic viscosurgical device (OVD) for stripping proliferative membranes during vitrectomy in patients with complex proliferative diabetic retinopathy (PDR). METHODS: This was a prospective cohort study that enrolled 28 patients (30 eyes) diagnosed with complex PDR at the Affiliated Eye Hospital of Nanjing Medical University. The patients were randomly divided into two groups based on different surgical procedures: The patients who received vitrectomy combined with OVD-assisted internal limiting membrane peeling were assigned to Group A (15 eyes of 13 patients), while Group B patients (15 eyes of 15 patients) underwent vitrectomy without OVD-assisted internal limiting membrane peeling. The primary outcomes measured included intraoperative bleeding, operation duration, electrocoagulation for hemostasis, occurrence of iatrogenic retinal holes, postoperative best-corrected visual acuity (BCVA), and complications such as recurrent retinal detachment and vitreous hemorrhage. RESULTS: Compared with the mean preoperative BCVA, the mean postoperative BCVA at the last follow-up improved significantly in both groups (all p < 0.05), but no significant difference in mean BCVA improvement was found between the two groups (p > 0.05). Regarding intraoperative complications, no iatrogenic retinal tears or retinal detachments occurred in any group. Intraoperative observations revealed that the preretinal injection of OVD facilitated the rapid separation of fibrous vascular membranes from the retina, while also serving a hemostatic function, thus maintaining a clear visual field. In Group A, photocoagulation was utilized for hemostasis in two eyes, whereas in Group B, it was employed in 9 cases, with a statistically significant difference between the groups (p < 0.05). The average surgical duration was 37.47 ± 4.69 min for Group A and 52 ± 6.26 min for Group B, with a statistically significant difference noted (p < 0.05). No iatrogenic retinal holes, recurrent vitreous hemorrhages, retinal detachments, choroidal hemorrhages, or endophthalmitis were observed in both groups. CONCLUSION: Our study demonstrates a new application of OVD in proliferative membrane removal during vitrectomy, particularly in patients with PDR characterized by strong adhesions and complex structures. This method offers a potentially safer and more effective option for treating patients with PDR.