Abstract
Purpose::
To evaluate pertinent risk factors for development of light perception (LP) and no light perception (NLP) vision following vitrectomy in diabetic patients
Methods::
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.
Results::
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.
Conclusions::
Diabetic patients with post-operative NVI, VH and uncontrolled glaucoma are at risk for developing poor final visual outcomes - LP or NLP after vitrectomy.
Keywords: diabetic retinopathy • clinical (human) or epidemiologic studies: outcomes/complications • retina