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D. P. Shah, N. Nayak, M. Pham, M. Zarbin, N. Bhagat; Variables Affecting the Visual Prognosis in Diabetic Retinal Detachment Repair: A Retrospective Review. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5080.
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To identify variables that may affect functional outcome in diabetic eyes that undergo tractional retinal detachment (TRD) repair.
A retrospective chart review of diabetic eyes that underwent a pars plana vitrectomy (PPV) by surgeons N.B. and M.Z. between 1999-2006 at New Jersey Medical School for either a TRD or a tractional rhegmatogenous RD (TRRD) with or without vitreous hemorrhage (VH). Statistical analysis was performed using Chi Square and Fischer’s Exact tests. Preoperative variables assessed included age, gender, hypertension, type of retinal detachment, status of macula, VH, visual acuity (VA), intraocular pressure (IOP), cataracts, and intraocular lens (IOL). Intra-operative factors assessed included whether a pars plana lensectomy (PPL) was performed, IOL placement and type of tamponade; post-operative factors included IOP, complications and presence of cataract.
214 eyes were identified - 128 males and 86 females. Mean age of the patients was 52 years (range: 23-73). Mean number of PPVs to attach the retina was 1.12 (range: 1-3). Mean preoperative VA in logMAR was 1.55 and mean post-op VA was 1.19. 11% (24 eyes) were phakic while 4% (9 eyes) were pseudophakic; 16% (33 eyes) underwent lensectomy at the time of PPV; 14% (30 eyes) underwent cataract surgery within 1 year of PPV while 22% (47 patients) overall underwent cataract surgery. Univariate analysis showed that patients older than 50 years (p=0.007), a poor preoperative visual acuity of ≥20/200 (p=0.004), use of tamponade (p=0.002), either c3f8 (p=0.002) or silicone oil (p=0.002), and performing an intraoperative PPL (p=0.01) were associated with a poor visual outcome of ≥20/200. Patients were also more likely to have a post-operative VH either if they had hypertension (p=0.04) or poor preoperative visual acuity (p=0.0005).
Certain preoperative and intra-operative factors can have a significant effect on the visual prognosis of diabetic patients undergoing PPV for TRD or TRRD repair. These factors need to be recognized by surgeons and may be extremely helpful in discussing patients’ visual prognosis.
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