Outcomes of Diabetic Tractional Retinal Detachments in Patients with Chronic Kidney Disease

Abstract

Purpose : Tractional retinal detachments (TRD) are a late complication of diabetic retinopathy (DR). We describe characteristics and outcomes of diabetic patients with stage III chronic kidney disease (CKD) who had TRD repair.

Methods : A retrospective review of patients who had surgery for TRD from Jan 2013 to April 2015 by one surgeon was conducted. Exclusion criteria: patients with renal function better than stage III CKD, defined as creatinine (Cr) >1.0 and glomerular filtration rate (GFR)<60, and follow up <6 months. Demographics, pre-operative Cr, GFR, visual acuity (VA) in Snellen and LogMAR, type of surgery, and post-operative vision, retinal status, and complications were recorded.

Results : A total of 58 patients underwent 70 surgeries for TRD repair, of which 35 (60%, 41 eyes) had at least CKD stage III. 17 patients (15 males, 2 females; mean age 54.7 years) with 21 eyes fulfilled all inclusion criteria. 13 were on insulin at the time of surgery. Mean Cr was 3.6 (SD 1.8) with GFR of 25.5 (SD 15.2). 5 of 17 patients (3 of the 4 patients that had both eyes in the cohort) were on dialysis.
Table 1 shows mean LogMAR vision prior to surgery. 18 of 21 eyes were phakic; 62% had received prior pan retinal photocoagulation. The detachment involved the macula in 11 eyes and 12 had combined rhegmatogenous–tractional RD; 16 eyes had vitreous hemorrhage (VH). All patients underwent pars plana vitrectomy (PPV), membrane peel and endolaser; 15 received intraocular tamponade (8 with silicone oil, 4 with SF₆, 3 with C₃F₈). Mean follow up time was 12 months. At 1 month after surgery, mean VA was CF (Table 1) and all patients achieved anatomical success; 2 had mild VH and 1 had epiretinal membrane. At month 6, average VA was CF (Table 1); 4 eyes (24%) were NLP due to severe ischemia. At 1 year (n=11) mean VA was CF, and 1 more patient became NLP due to neovascular glaucoma. 2 patients required repeat PPV (1 for VH and 1 for recurrent TRD) and achieved anatomic success. Additional surgeries were oil removal (n=2) and cataract extraction (6 of 18 phakic eyes), both at a mean of 7 months after TRD repair.

Conclusions : Patients undergoing TRD repair with stage III or worse CKD have guarded visual prognosis; 24% (5/21) of eyes became NLP despite 95% anatomic success with one surgery (overall, 100% anatomic success). Only 1 eye needed a 2^nd surgery for recurrent RD.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Table 1. Pre- and post-operative vision