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Fibrinoid syndrome: a severe complication of vitrectomy surgery in diabetics
Abstract:
Two hundred eighty consecutive vitrectomies in diabetic patients were studied retrospectively. In 15 eyes, interlacing fibrin-like strands appeared on the surface of the retina and behind the iris plane from two to 14 days postoperatively. One or two days later, a gelatinous mass formed in the center of the vitreous activity, leading to the development of tractional retinal detachment and rubeosis iridis with neovascular glaucoma. Large doses of systemic and topical corticosteroids reversed the fulminating course of this complication in six of 15 eyes. The combination of lens surgery or scleral buckling procedure with vitrectomy, and the presence of retinal detachment preoperatively seemed to predispose to this complication. It is possible that multiple surgical procedures performed during the same operation cause an increase in vascular permeability resulting in the formation of a gelatinous, fibrin-like material in the diabetic eye.
Insights
Diabetic vitrectomies can lead to vision-threatening complications like retinal detachment and neovascular glaucoma due to fibrin-like strands. Corticosteroids may reverse this severe complication in some cases.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Diabetic Retinopathy Management
Background:
- Diabetic retinopathy is a leading cause of blindness.
- Vitrectomy is a common surgical procedure for managing complications of diabetic retinopathy.
- Postoperative complications can significantly impact visual outcomes.
Purpose of the Study:
- To investigate a specific postoperative complication following vitrectomy in diabetic patients.
- To identify predisposing factors and potential treatments for this complication.
Main Methods:
- Retrospective study of 280 consecutive vitrectomies in diabetic patients.
- Observation and documentation of postoperative complications, including fibrin-like strands, gelatinous masses, tractional retinal detachment, rubeosis iridis, and neovascular glaucoma.
- Analysis of patient history, surgical procedures, and treatment outcomes.
Main Results:
- 15 out of 280 eyes developed interlacing fibrin-like strands 2-14 days postoperatively.
- This was followed by a gelatinous mass, tractional retinal detachment, rubeosis iridis, and neovascular glaucoma.
- Systemic and topical corticosteroids reversed the complication in 6 of the 15 affected eyes.
- Combined lens surgery or scleral buckling with vitrectomy, and preoperative retinal detachment were predisposing factors.
Conclusions:
- A specific fibrin-related complication can occur after vitrectomy in diabetic patients, potentially leading to severe vision loss.
- Early identification and treatment with corticosteroids may be beneficial.
- Combined surgical procedures and preoperative retinal status are important considerations.