Abstract
Purpose :
To determine the outcomes of patients undergoing pars plana vitrectomy (PPV) surgery for complications of proliferative diabetic retinopathy (PDR).
Methods :
Retrospective, observational chart review of 291 eyes of 217 patients that underwent PPV for complications of PDR at a large county hospital in Dallas, Texas from 2014 to 2019. Outcome measures included retinal re-attachment success rate, best-corrected visual acuity, and need for repeat PPV. Patients were excluded if they had less than 6 months of follow-up.
Results :
Patients were 55.8% male and 44.2% female with an average age of 51 years (standard deviation (SD) of ± 9.5). Patients were followed for an average of 27.6 months, with a range of 6 to 71 months. The average Hgb A1c at time of surgery was 8.1 (SD ± 2.0). 72.3% of patients had their insurance covered by charity and 18.2% were covered by Medicaid/Medicare. 202 (93.1%) patients had other vascular risk factors or complications from diabetes, including hypertension (88.0%), hyperlipidemia (54.8%), chronic kidney disease (43.3%), need for dialysis (12.4%), coronary artery disease (8.8%), peripheral neuropathy (7.8%), need for amputation (7.4%), myocardial infarction (6.9%), and stroke (6.5%).
PPV surgery was performed for non-clearing vitreous hemorrhage in 110 eyes (37.8%), tractional retinal detachment (TRD) involving the macula in 98 eyes (33.7%), TRD not involving the macula in 50 eyes (17.2%), combined TRD and rhegmatogenous retinal detachment in 19 eyes (6.4%), and vitreomacular interface abnormalities in 14 eyes (4.7%). 81 eyes (27.8%) required gas tamponade and 29 eyes (10.0%) required silicone oil.
Average logMAR visual acuity was 1.75 (SD ± 0.74) pre-operatively and 0.92 (SD ± 0.87) at 1 year post-op. Retinal re-attachment success rate for patients with TRDs was 77.6% at 6 mo, 62.1% at 1 year, and 88.8% at most recent follow up. Common post-op complications included VH within 6 mos and cataracts. As of the most recent follow-up, 79 eyes (27%) needed repeat PPV and 91 (31.2%) needed cataract extraction (CE).
Conclusions :
This study shows that vitrectomy is an overall safe and effective procedure that improves vision and stabilizes the retina in those with complications from PDR.
This is a 2021 ARVO Annual Meeting abstract.