Abstract
Purpose: :
To compare visual outcome and complication rates after pars plana vitrectomy (PPV) alone versus PPV combined with phacoemulsification and intraocular lens implantation (PPVCE) in diabetic patients.
Methods: :
Retrospective chart review of all diabetic patients undergoing PPV with or without CE between Jan 2003 and Dec 2006 at the Joslin Diabetes Center. PPV was performed by a single surgeon and phacoemulsification by 1 of 3 surgeons immediately preceding PPV. ETDRS protocol refraction & visual acuity (VA), IOP, clinical ETDRS retinopathy severity, retinal biomicroscopy and Zeiss OCT3 retinal thickness measurements were obtained from the ophthalmic record using standardized forms (pre-op; post-op: 1 day; 1, 4, 12, 24 wks; and at last follow-up).
Results: :
251 eyes (122 PPV, 129 PPVCE) of 225 diabetic patients were evaluated. Primary indications for vitrectomy in PPV & PPVCE, respectively, were vitreous hemorrhage (35%,29%), ERM and/or diabetic macular edema (38%,65%), and traction retinal detachment (27%,6%). Median pre-op VA was 20/100 (quartiles: low 20/63, high 20/600) and median post-op VA was 20/50 (20/25,20/100). Subjects undergoing PPVCE had better pre-op VA (p=0.025), were older, had less prior PRP & focal laser, and more frequent history of HTN or hyperlipidemia. Post-op VA improved following both PPV & PPVCE (p<0.001). Post-surgical VA change did not differ between surgical approaches when corrected for pre-op VA. Early post-op VA change was significantly better in PPVCE, but was equivalent by 12 wks. Eyes receiving PPV with subsequent CE (N=16) and those receiving simultaneous PPVCE (N=129), each had significant VA improvement which was of similar magnitude. Complication rates did not differ between groups. In the 24 & 48 eyes with ME due to ERM undergoing PPV or PPVCE, respectively, both groups had improvement in OCT central subfield thickness (p<0.05). Improvement in both retinal thickness and percent thickening was greater in the PPVCE group (-148 microns, -82%) than in the PPV group (-54 microns, -33%, p<0.001).
Conclusions: :
PPV combined with simultaneous CE in diabetic patients did not appear to significantly increase complications or result in reduced VA as compared with PPV alone or PPV with subsequent CE. Greater early visual benefit was observed following PPVCE, but final visual outcome did not differ. In the subset of eyes with ME induced by ERM, PPVCE resulted in greater reduction of both retinal thickness & thickening than PPV alone.
Keywords: diabetic retinopathy • vitreoretinal surgery • cataract