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N. Stone, A. Hall, D. Yorston; Indications and Outcomes in Vitrectomy for Proliferative Diabetic Retinopathy in East Africa. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2746.
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Diabetes mellitus is an important public health problem worldwide. In sub-Saharan Africa, its current incidence is 10 million. This is expected to rise to almost 20 million by 2025.Although laser treatment may prevent sight threatening disease, some patients will need a vitrectomy for advanced proliferative retinopathy. The following multi-centre retrospective audit is the first study to demonstrate the effectiveness of vitrectomy in restoring useful vision to a blind diabetic population in East Africa.
Retrospective analysis of case notes from patients undergoing vitrectomy for advanced proliferative diabetic retinopathy at two hospitals in East Africa (Kilimanjaro Christian Medical Centre, Tanzania and Kikuyu Eye Unit, Kenya). All patients with follow-up of at least four weeks were included. Surgery was performed by three different vitreoretinal surgeons.
Initial data were compiled for a total of 101 patients (115 eyes). Main indications for surgery were vitreous haemorrhage (28%) and tractional retinal detachment (72%).Preoperatively 56 (55.4%) patients were blind (vision <20/200 in the better eye). Following vitrectomy 68% patients had vision of 20/200 or better whilst only 32% had vision of less than 20/200. The number needed to treat to restore sight to one blind person was 4.3 suggesting vitrectomy is a cost-effective surgical intervention in this population. Cataract was the most common post-operative complication occurring in 41.2% of eyes, with visual outcome no worse in eyes that subsequently underwent cataract surgery.
This is the first study to demonstrate that vitrectomy restores useful vision to diabetic patients in Africa. As the prevalence of diabetes escalates the need for treatment of advanced retinopathy will increase. Acceptable surgical outcomes are achievable and this audit confirms that vitrectomy should be considered a cost-effective intervention in the treatment of proliferative diabetic retinopathy in the developing world.
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