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Prisca A. Diala, Paolo S. Silva, Ahmed Z. Soliman, Jennifer K. Sun, Paul G. Arrigg, Sabera T. Shah, Timothy L. Murtha, Deborah K. Schlossman, Rola Hamam, Lloyd P. Aiello; Visual Outcomes from Pars Plana Vitrectomy versus Combined Pars Plana Vitrectomy, Phacoemulsification and Intraocular Lens Implantation in Diabetic Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4421.
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To compare visual acuity (VA) and diabetic retinopathy (DR) outcomes over a 4 yr period after pars plana vitrectomy (PPV) versus combined PPV, phacoemulsification and intraocular lens implantation (PPVCE) in patients with diabetes mellitus (DM).
Retrospective chart review of all DM patients undergoing PPV or PPVCE between 4/1/2001-12/31/2006 at the Joslin Diabetes Center. PPV was performed by a single retinal surgeon. CE was performed by 1 of 3 surgeons prior to PPV. ETDRS protocol VA, DR severity, and postop complication data were recorded on standardized forms for pre- & postoperative visits up to 4 yrs.
251 eyes of 222 patients were evaluated (PPV:122, PPVCE:129). Follow-up at 4 yrs occurred for 161 eyes (64%). Median age was 64 y (Q1,Q3: 55,70), DM duration 27 y (18, 35), HbA1c 7.8% (6.9, 8.9); 48% male, and 45% Type 1 DM. The PPVCE group had better preop VA (20/80 vs 20/160, p=0.03), less baseline PDR (66% vs 89%, p<0.0001), older patients (64 vs 60 yrs, p=0.0005), more hyperlipidemia (85% vs 71%, p =0.009) and more HTN (91% vs 81%, p=0.03). Postop VA improved in both groups but PPV eyes improved more at years 2, 3, & 4 [median letter improvement (15 vs 10), (20 vs 10), (22 vs 11), p =0.02, 0.04, 0.05 respectively]; however these differences were not significant after adjusting for preop VA. At 4 yrs, PPV group VA was not better [(20/32 vs 20/50 (p=0.08)] and there was no difference in DR progression between the groups. At years 2, 3, & 4, more PPVCE eyes developed neovascular glaucoma (NVG) [(8.6% vs 1.2%), (11.8% vs 1.2%), (8.2% vs 2.3%), p= 0.03, 0.01, 0.05, respectively] and this was significant even after correcting for baseline DR, age, hyperlipidemia and hypertension. At 4 yrs (adjusted for preop VA), VA was worse in eyes with NVG in the combined cohort (20/60 vs 20/40, p=0.01, 11 NVG eyes) and in the PPVCE group (20/1000 vs 20/50, p<0.001, 9 NVG eyes). There was no difference between the groups in the incidence of other postop complications (eg vitreous hemorrhage & traction retinal detachment).
Substantial visual improvement occurs over the 4 yrs following either PPV or PPVCE in patients with DM. Although PPVCE visual outcomes were not significantly worse than those after PPV alone, over this period there was a higher rate of NVG and associated VA loss.
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