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Priya Gupta, Kiley Boone, Miriam B. Zimmerman, James C. Folk, Vinit B. Mahajan, Stephen R. Russell, H C. Boldt, Elliott H. Sohn; Pars Plana Vitrectomy for Tractional Retinal Detachment Secondary to Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1334.
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To determine outcomes of pars plana vitrectomy (PPV) for eyes with traction retinal detachment (TRD) due to proliferative diabetic retinopathy (PDR).
We conducted a retrospective chart review on patients who underwent PPV for TRD due to PDR at the University of Iowa Hospital and Clinics from 1/1/2001 to 1/1/2011. IRB approval was obtained. Exclusion criteria included prior PPV and absence of recent pre-operative visual acuity. Detailed pre-, intra-, and post-operative data were compiled. Statistical analysis was performed.
240 eyes representing 202 patients were analyzed. There were 106 (44.4%) right eyes and 133 (55.6%) left eyes. 38 patients (24 males, 14 females) met the inclusion criteria for both eyes (15.8%). The mean age at the time of surgery was 48 years old (median=48, range 21 to 88). 214 eyes were phakic and 25 were pseudophakic at the time of surgery. Median VA at pre-op, 3, 6, 12, and 60 months post-op was 20/320 (n=240), 20/125 (n=201), 20/100 (n=170), 20/125 (n=134), and 20/80 (n=57), respectively. In eyes with pre-operative VA of 20/80 or worse, there was a statistically significant improvement in VA at all time points (p<0.0001) for those with pre-operative vitreous hemorrhage. No statistically significant improvement in VA was found for those with pre-operative VA of 20/70 or better, or those without vitreous hemorrhage. 15 (6.3%) eyes required re-operation due to retinal detachment. 3 (1.3%) eyes required enucleation.
For patients with better VA, the benefits of PPV for TRD were unclear, perhaps because of longstanding or severe macular disease. These patients are at particularly high risk for visual loss as contralateral TRDs were common. Evaluation of those with better pre-operative VA using other visual measure such as contrast sensitivity, visual field, and/or structural tests such as OCT may be more likely to demonstrate a statistical difference.
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