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M. M. Pham, S. Deas, M. Zarbin, N. Bhagat; Factors Affecting the Functional Outcome in Diabetics Undergoing Pars Plana Vitrectomy for Tractional Retinal Detachment Repair and Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1370.
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To assess pre-operative risk factors that predetermine final visual acuity (FVA) in diabetic patients undergoing pars plana vitrectomy (PPV) for tractional retinal detachment (TRD) repair and/or vitreous hemorrhage (VH).
Retrospective chart review of all diabetic patients who underwent PPV by one surgeon, NB, between March 2001 and July 2006. Indications for PPV included: vitreous hemorrhage (VH), tractional retinal detachment (TRD), and combined rhegmatogenous (RRD) and TRD. Using Chi Square, Fisher’s Exact test, and linear regression model, 19 variables were assessed for their impact on post-operative FVA, categorized as ≥20/200, <20/200, and < count fingers (CF). Variables assessed included age, gender, diabetes type, hypercholesteremia, hypertension, pre-op VA, RD type, macular involvement, intraocular pressure, anatomical retinal status, iris neovascularization, cataract, pseudophakia or aphakia, corneal edema, hyphema, glaucoma, vitreous hemorrhage, history of macular edema, and history of pan-retinal photocoagulation.
One hundred and forty-six (n= 146) surgical eyes were included - those with TRD, or combined TRD with RRD, with or without VH. Univariate analysis of the subjects with TRD showed that age older than 50 years (p=0.001), a poor preoperative visual acuity less than 20/200 (p=0.002) and detached macula (p=0.038) were the preoperative variables associated with a poor visual outcome. Multiple logistic regression analysis showed that a poor preoperative visual acuity less than 20/200 and age greater than 50 years were the strongest predictors of an increased risk of a poor visual outcome. Subjects who had TRD without VH (p=0.011) were shown to have decreased risk for a poor visual outcome.
Pre-operative risk factors that can predeterminate post-operative FVA outcomes after PPV in diabetics with TRD +/- VH need to be thoroughly evaluated. These results should be taken into consideration when discussing the visual prognosis in such patients.
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