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  • Title: Trimanual Versus Unimanual 23-Gauge Vitrectomy in Patients With Diabetes: Limitations and Expectations.
    Author: Elwan MM, Hagras SM, Ellayeh AA.
    Journal: Ophthalmic Surg Lasers Imaging Retina; 2019 Jan 01; 50(1):42-49. PubMed ID: 30640395.
    Abstract:
    BACKGROUND AND OBJECTIVE: To compare between trimanual and unimanual vitrectomy in complicated proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: A prospective, non-randomized, comparative study including patients with tractional retinal detachment (TRD), vitreous hemorrhage with TRD, and combined TRD with rhegmatogenous retinal detachment. The patients were allocated into two groups: the unimanual group with three-port vitrectomy and the trimanual group with added fourth sclerotomy, through which the endoillumination probe was guided by the assistant. The primary outcomes included the intraoperative feasibility, operative time, and complications. RESULTS: Eighty-two eyes were categorized into the two groups: 44 eyes in the unimanual group and 38 eyes in the trimanual group. Operative time was significantly shorter in the trimanual group (P < .005). The incidence of iatrogenic breaks and intraoperative bleeding was significantly higher in the unimanual group (P = .034 and P = .044, respectively). Primary anatomic success was achieved in 90.9% and 94.7% in unimanual and trimanual groups, respectively, without significant difference (P = .411). There was no significant difference in the postoperative complications. CONCLUSIONS: Trimanual vitrectomy was proven to be a safe and effective technique in managing complicated PDR. It results in anatomical outcomes comparable to standard unimanual vitrectomy with fewer intraoperative complications. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:42-49.].
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