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Aishat Mohammed, Philip H. Scharper, Olga Shif; Role of primary pars plana vitrectomy in early active proliferative diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6362.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the role of primary pars plana vitrectomy (PPV) in patients with early active proliferative diabetic retinopathy (PDR).
A retrospective review of patients with PDR was performed. Eyes with previous PPV, PRP, fibrovascular tractional detachments (TRD) or with other non-PDR NV were excluded. Eyes that met the inclusion criteria were divided into 3 treatment groups: Group A (PRP alone, one session, complete 360o treatment), Group B (PPV alone), and Group C (PPV/PRP). All eyes received at least one anti-VEGF injection prior to treatment. Diode (IQ 537, Iridex) or argon (Visulas 532S, Zeiss) laser was used for Group A whereas argon laser only was used for Group C. 23G PPV (Constellation, Alcon) was performed using intravitreal triamcinolone to ensure complete vitreous removal. Primary outcome measure was the development of new areas of NV on fluorescein angiography (FA) requiring additional treatment.
38 eyes in 24 patients met inclusion criteria; 9/24 (37.5%) in Group A, 8/24 (33.3%) in Group B, and 21/38 (55.2%) eyes in Group C. 8/9 eyes (88.8%) in Group A developed new areas of NV compared to 1/8 eyes (12.5%) in Group B and 2/21 eyes (9.5%) in Group C. The average time to development of new NV was 13.3 months in Group A, 15 months in Group B, and 10 months in Group C. Of the 8 eyes that developed new NV in Group A, 2/8 (25%) developed TRD and 3/8 (37.5%) developed VH; all 5/8 (62.5%) required anti-VEGF injections, PPV and additional PRP. None of the eyes in Groups B and C required repeat PPV. Mean follow up was 27 months for Group A, 15 months for Group B, and 13.5 months for Group C.
Advances in small gauge PPV make earlier surgery feasible for eyes with PDR. Our results suggest that early PPV is protective against the development of new NV and reduces the need for additional treatment. Early PPV in diabetic eyes may reduce the overall treatment burden by improving oxygenation and hastening removal of pro-angiogenesis factors. Moreover, PRP prior to PPV may cause broad vitreoretinal adhesions, which not only make complete vitreous removal difficult but also increase the risk of intraoperative retinal breaks. Additional prospective studies are needed.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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