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Tadashi Muraoka, Atsushi Tanaka, Masaru Takeuchi; Correlations between the Preoperative Status of Glycemic Control and the Outcome of Vitrectomy for Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5351.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the outcomes of vitrectomy for proliferative diabetic retinopathy by the preoperative status of glycemic control.
Subjects were 112 eyes of 90 Japanese patients (age 57.3±12.8, range 29-90 y/o ) with PDR who underwent 23-gauge or 25-gauge pars plana vitrectomy at National Defense Medical Collage Hospital between April 2011 and December 2012. Subjects were divided into groups according to preoperative HbA1c and fasting blood sugar levels (BS). Group 1 was based on preoperative BS : Group 1A was preoperative BS ≧ 200 mg/dl (n = 28 eyes), and Group 1B was preoperative BS < 200 mg/dl (n = 84 eyes). Group 2 was based on preoperative HbA1c : Group 2A was HbA1c ≧ 8.5 (n = 28 eyes), and Group 2B was HbA1c < 8.5 (n = 84 eyes). Patients’ background, preoperative and the latest postoperative best corrected visual acuity (BCVA), and preoperative and postoperative complications were analyzed. Multiple logistic regression analysis was used to assess the risk factors for poor postoperative visual acuity.
In Group 1, significant differences between Group 1A and 1B were observed in age (51.7 ± 13.8 vs. 59.2 ± 12.0 y/o), preoperative HbA1c (8.2±2.0 vs. 7.2±1.3%), preoperative BCVA < 20/200 (82.1 vs. 59.5%), postoperative laser photocoaglation treatment (50.0 vs. 26.2%), postoperative complications of neovascular glaucoma (28.6 vs. 7.1%), , silicone oil injection (10.7 vs. 1.2%), postoperative BCVA < 20/200 (35.7 vs. 14.3%), and operation for glaucoma (14.3 vs. 3.6%). In Group 2, there were significant differences between Group 2A and 2B in preoperative BS (220 ± 84 vs. 141 ± 55 mg/dl), preoperative laser photocoaglation treatment (82.1 vs. 61.9%), the presence of retinal tears or detachments (53.6 vs. 28.6%), and gas injection at the end of surgery (47.6 vs. 25.0%). Multivariate analysis indicated that the factors for poor postoperative visual acuity (BCVA < 20/200) are preoperative BS (>200mg/dl; range odds ratio, 4.7), the presence of retinal tears or detachments (range odds ratito, 4.6), and preoperative complications of glaucoma (range odds rate, 3.7). (p<0.05)
These results demonstrated that preoperative BS ≧ 200 mg/dl is a risk factor and a prognostic factor of postoperative BCVA < 20/200.
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