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Ayumi Usui, Masatoshi Kiyokawa, Toshiro Sakuma, Rei Ito, Nobuyuki Ebihara; Surgical and visual outcome and prognostic factors following vitrectomy in diabetic tractional retinal detachment. Invest. Ophthalmol. Vis. Sci. 2013;54(15):202.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the prognosis and prognostic factors of patients undergoing vitrectomy for tractional retinal detachment (TRD) in eyes with proliferative diabetic retinopathy (PDR)
Retrospective chart review of patients with diabetic tractional retinal detachment who underwent pars plana vitrectomy (PPV) between November 2008 and April 2012. Subjects were 86 consecutive cases of 72 patients who had follow-up for at least 6 months. Variables assessed were: age, gender, hemoglobin A1c (HbA1c), macular involvement, anatomical retinal status, visual acuity, surgical methods, post-operative retinal status and visual acuity, and surgical complications. The mean post-operative follow-up duration was 19.8 ± 11.3 months (range, 6 to 44 months). We detected an inter-group difference using Fisher’s exact probability test.
There were 65 men, 21 women with an average age of 50.8±12.0 years old. The mean HbA1c was 8.0±2.2%. The average logMAR visual acuity before operation was 1.4±0.79 and macula-involving RD was found in 34 eyes. The final postoperative visual acuity was improved more than 0.2 logMAR in 64 eyes (74.4%), was unchanged in 14 eyes (16.3%) and decreased in 8 eyes (9.3%). Air or SF6 were used in 43 eyes (50.0%), while in 12 eyes (14.0%) we used silicone oil for retinal tamponade, while retinas in 37 eyes (43.0%) were reattached without gas or silicone oil tamponade. Final retinal reattachment was achieved in 82 eyes (95.3%). Re-operation was required in 18 eyes (20.9%). Neovascular glaucoma (NVG) following vitrectomy occurred in 3 eyes (3.5%) and proliferative vitreoretinopathy (PVR) following vitrectomy occurred in 13 eyes (15.1%). Cases without panphotocoagulation (PRP) before vitrectomy, cases with macula-involving RD, cases with TRD extending beyond the quadrant, cases with TRD in temporal retina, cases with proliferative PVR, and cases occurred NVG following vitrectomy were significantly associated with poorer of final postoperative visual acuity (p<0.05).
The poor prognostic factors of TRD in eyes with PDR were pre- operative PRP, macula-involving TRD, TRD on the temporal side, and TRD complications following vitrectomy, in particular, NVG and PVR.
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