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Madina Holmuhamedova, Siddarth Rathi, Steven Ness; Evaluation Of Surgical Outcomes After Pars Plana Vitrectomy For Diabetic Tractional Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2626.
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© ARVO (1962-2015); The Authors (2016-present)
To review outcomes in patients treated with pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD).
Retrospective chart review of patients undergoing PPV for diabetic TRD from 2005 to 2010 at Boston Medical Center.
Fifty-three eyes of 43 patients were included in the study. Twenty patients were male, twenty three were female, and average age was 52.5 years old. Average duration of diabetes (DM) was 18 yrs (range 2-48), and 29 patients had duration of DM less than 20 yrs. Preoperative HgA1c was available in 39 of 53 cases, with average HgA1c value of 9.2. Preoperative best-corrected visual acuity (BCVA) was 20/550, range 20/60-LP (logMAR 1.44, range 0.48-4). Postoperative BCVA improved to 20/296, range 20/20-NLP (logMAR 1.17, range 0-4, 5 NLP), and 21 of 53 eyes (39.6%) gained at least 2 lines of vision. Twenty-four of 53 eyes (45.2%) required at least one additional surgical procedure, but 43 of 53 eyes (81.1%) had a fully attached retina at final follow up. Univariate analysis identified duration of DM greater than 20 years (logMAR 0.81 vs. 1.46, P 0.02) and the absence of preoperative vitreous hemorrhage (logMAR 0.91 vs. 1.4, P 0.09) as significant predictors of better postoperative BCVA. Surgery for TRD involving the macula yielded worse visual acuity outcomes (logMAR 1.35 vs. 0.79, P 0.08), although these patients also had significantly worse preoperative BCVA. Intra-operative characteristics predictive of worse visual acuity outcomes were intra-operative retinal breaks (logMAR 1.42 vs. 0.65, P 0.001) and the need for silicone oil tamponade (logMAR 2.01 vs. 0.97, P 0.05). Analysis revealed no significant relationship between post-operative VA and history of preoperative PRP or bevacizumab, lens status, age, HgbA1C, or post-operative vitreous hemorrhage.
In patients undergoing PPV for diabetic TRD, significant improvements in surgical techniques and instrumentation have translated into anatomic success. This study demonstrates that while average visual acuity does improve following vitrectomy, a significant proportion of patients will require additional surgical procedures, and the advanced nature of the underlying ischemic retinopathy often limits outcomes.
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