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Ian D Kirchner, John P. McLaughlin, Bao Dinh, Philip Henry Scharper; Incidence of pars plana vitrectomy for complications related to proliferative diabetic retinopathy in patients previously treated with panretinal photocoagulation.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):874. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the incidence of patients requiring pars plana vitrectomy (PPV) for complications related to proliferative diabetic retinopathy (PDR) occurring within five years following treatment with panretinal photocoagulation (PRP).
A retrospective review of 176 eyes from 100 diabetic patients that had received partial or total PRP for PDR was performed. Patients treated with PRP between 7/2005 and 11/2015 at Retina Specialists of Alabama in Montgomery and followed for at least five years were included. Eyes with intraocular surgery prior to PRP or concomitant retinal disease were excluded, along with patients with a history of systemic disease that could contribute to retinal microvascular disease. Primary outcome measures include incidence of PPV and indication for surgery.
98/176 eyes (56%) underwent PPV to treat complications related to PDR within 5 years following treatment with PRP. Indications for surgery included tractional retinal detachment (41/98), non-clearing vitreous hemorrhage (34/98), symptomatic epimacular proliferation (21/98), vitreous hemorrhage with tractional retinal detachment (1/98), and vitreous hemorrhage with epimacular proliferation (1/98). The mean number of laser burns was greater in eyes ultimately requiring surgery (1948 in progressed eyes, 1639 in non-progressed eyes), however, no statistically significant difference between the two groups was found.
Fifty-six percent of eyes previously treated with PRP ultimately required vitrectomy within five years after laser treatment due to complications related to diabetic retinopathy, most commonly tractional retinal detachment. In addition, the response of PDR to PRP was not significantly related to cumulative number of argon laser burns. These data call into question the long-term efficacy of PRP in preventing surgical intervention due to PDR progression. Additional prospective studies investigating alternative approaches may be warranted.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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