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Shulamit Schwartz, Ramanath Bhandari, Adiel Barak, Naresh Mandava, Anat Loewenstein, Hugo Quiroz-Mercado; Visual and surgical midterm outcome of minimally invasive pars plana vitrectomy for diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2303. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcome and complications rate of minimally invasive pars plana vitrectomy (PPV) in diabetic patients with complications of proliferative diabetic retinopathy (PDR).
Retrospective, interventional, consecutive case series. 117 patients who underwent 144 small gauge (23 or 25) PPV for PDR were included. Main indications were none clearing vitreous hemorrhage (NCVH) in 78 eyes, tractional retinal detachment (TRD) in 33 eyes and macular pathologies in 18 eyes. 36% had a combined vitrectomy and cataract extraction. Primary outcome was change in visual acuity (VA) 3 and 6 six months after operation. Secondary outcomes were complications rate and risk factors.
Mean age was 54.5±10.2 years. Mean diabetes duration was 12.3±8 years. 21.4% had Type I diabetes, 63.4% of all patients were treated with Insulin and 32.5% required dialysis perioperatively. Mean HbA1c was 8.4% ±1.9. 29.1% of patients had more than one vitrectomy overall. Mean pre-operative VA was 1.62 logMAR. 81.9% of eyes were legally blind at the time of operation with 6 showing light perception (LP), 25 detecting hand movements (HM), and 54 counting fingers (CF). At 3 and 6 months post-operative visits, mean VA improved to 1.2 and 1.13 logMAR respectively (p<0.0001). At 6 months only 55 eyes (38.2%) had poor VA of 1.0 logMAR or less, with 2 with no LP, 3 showing LP, 12 detecting HM, and 13 CF. In all, 63.6% of eyes with TRD and 68.4% with NCVH achieved a better VA than 1.0 logMAR at 6 months. VA was preserved in 43 patients between visits. Hispanic race (p=0.018), Insulin treatment(p=0.042), prior cataract extraction(p=0.003), internal limiting membrane peeling (p=0.001) and operation length (p=0.0005) were found to be significant risk factors for less favorable VA at 3 and/or 6 months. Complications included NCVH (12.5%), TRD (4.9%), macular edema (4.9%), rubeosis (4.2%), neovascular glaucoma (2.8%),optic atrophy (4.2%), hypotony and phthisis (0.007%). Transient VH, ocular hypertension and hyphema occurred in 15.3%, 12.5% and 3.5% of eyes respectively. 23.1% of phakic eyes developed visually significant cataract. 11.8% required another vitrectomy for either NCVH or TRD.
Diabetic patients can observe improvement in VA with a low complications rate after minimally invasive PPV for PDR, which is maintained during mid-term follow-up.
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