The Effect of Vitrectomy as a Treatment for the Proliferative Diabetic Retinopathy in Young Patients

Abstract

Purpose: : To investigate the effect of vitrectomy as a treatment for the proliferative diabetic retinopathy(PDR) in young patients under 40 years old.

Methods: : Sixty eyes in 37 cases under 40 years old with PDR who had undergone vitrectomy at first time in Juntendo University Urayasu Hospital between September 2004 and December 2008 were included in this study. Preoperative condition, operation methods, visual acuity after operation, and complications during or after operation especially neovascular glaucoma(NVG) were reviewed retrospectively.

Results: : Visual acuity improved in Forty one eyes(68%) more than 0.2 log MAR before operation, remained stable in 5 eyes (7%), and deteriorated in 14 eyes(25%) more than 0.2 log MAR before operation. Optic atrophy and phthisis caused by NVG constituted 50% in the causes of complicated final visual acuity. After first time operation, 24 eyes(40%) needed re-operation, in which 15 eyes(25%) had NVG. Male patients had significantly higher prevalence of NVG after vitrectomy than female patients(p<0.05), and patients who took insulin as a treatment of diabetes mellitus and patients who kept phakia during operation had significantly lower prevalence of NVG after operation(p<0.05). Five eyes kept visual acuity more than 2/20 and 10 eyes did not among 15 NVG eyes. The patients whose visual acuity under 2/20 had significantly higher incidence of proteinurea at preoperation than other patients(p<0.05).

Conclusions: : In young PDR patients under 40 years old, postoperative NVG was the main factor for severe visual impairment. Multifactorial, both general and ophthalmic causes seem to be implicated in the onset and progression of NVG derived from PDR.

Keywords: diabetic retinopathy • vitreoretinal surgery • clinical (human) or epidemiologic studies: outcomes/complications