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S. Akbari, A. Hira, N. Bhagat; Risk Factors for Poor Vision of Light Perception or No Light Perception, in Diabetics Undergoing Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2248.
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To evaluate pertinent risk factors for development of light perception (LP) and no light perception (NLP) vision following vitrectomy in diabetic patients
The charts of all diabetic patients who underwent vitrectomy between August 2001 and July 2006 for vitreous hemorrhage (VH), tractional retinal detachment, combined rhegmatogenous tractional retinal detachments , or chronic macular edema with vitreomacular traction were reviewed. Diabetic eyes that had undergone initial vitrectomy elsewhere were excluded. All patients had a follow-up of at least 3 months. Using Fisher’s exact test, we assessed several variables for their impact on poor post-operative final visual acuity (FVA), defined as LP or NLP vision 1 month postoperatively. These variables included pre- and post-operative neovascularization of the iris (NVI), glaucoma, post-operative intraocular pressure (IOP), hyphema, VH, cataract, age, and pre-operative VA.
137 eyes of 124 diabetic patients were identified. The age ranged between 23 to 79 years (mean 52). There were 70 male patients and 56 females. At 1 month follow-up, 41% of patients had improved vision (more than or equal to 2 line improvement over pre-operative VA); 34% had stable vision, within 1 line of pre-operative VA and 25% had VA deteriorated ([more than or equal to 2 line decrement) from the pre-operative level. The best VA at 1 month post-operatively was [more than or equal to 20/40 in 13 (9.5%) of patients, 20/50 - 20/100 in 22 (16%) of patients, 20/120 to CF in 70 (51%), HM in 27 (20%), 3 (2 %) LP, and 2 (1.5%)NLP.5 out of 124 patients undergoing vitrectomy developed poor FVA. Preoperative vision in these patients ranged from CF to LP, with all patients demonstrating LP vision on the first post-operative day. 2 of these 5 patients developed NLP vision by the 2nd and 4th week post-operatively. Light perception persisted in the other 3 patients during the first postoperative month. Variables were assessed for their potential impact on poor FVA. Post-operative VH and NVI were significantly associated with poor FVA, with p value of 0.01 and 0.003, respectively. Pre-operatively, uncontrolled glaucoma (p=0.035) was also a risk factor for developing NLP or LP vision. However, pre-operative VA, NVI, hyphema, age, and cataract progression were not statistically significant risk factors. Post-operative IOP elevation was also not a statistically significant risk factor.
Diabetic patients with post-operative NVI, VH and uncontrolled glaucoma are at risk for developing poor final visual outcomes - LP or NLP after vitrectomy.
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