Abstract
Purpose :
As 27-gauge (27g) pars plana vitrectomy (PPV) for treatment of diabetic tractional retinal detachment (DM-TRD) becomes more widely practiced, there is a growing necessity to determine in which patients the procedure would be the most beneficial. We seek to evaluate pre-operative prognostic indicators for 27g PPV repair of diabetic tractional retinal detachment using a retrospective interventional case series analysis.
Methods :
Visual and anatomic outcomes of 110 eyes that underwent 27g PPV for repair of DM-TRD from 2013-2020 were evaluated with respect to various past medical history parameters via linear regression analysis.
Results :
The retina was successfully flattened at the end of all cases except one, and overall re-detachment rate was 10.9% (n=12). Pre-operatively, 80.2% (n=88) of patients were legally blind (logMAR > 1) compared to 56.3% (n=40) at postoperative month 6 (p<.001). Higher pre-operative logMAR visual acuity was associated with both greater odds of re-detachment (OR 4.95, p=.002) and worse visual acuity at month 6 (p<.001). Among the patient history parameters assessed, pre-operative use of dialysis (p=.038) and neovascularization of the iris (NVI) (p=.045) were associated with significantly worse visual acuity at month 6. Longer duration of diabetes in years was also associated less improvement in visual acuity from baseline at 6 months (p=.037). No medical history risk factors were identified for re-detachment.
Conclusions :
Our results suggest that 27g PPV remains a viable option for repair of DM-TRD with the additional finding that duration of diabetes, dialysis use, and presence of NVI prior to surgery represent negative risk factors of visual outcomes. Comprehensive pre-operative evaluation is required to better estimate prognosis and identify diabetic patients who may most benefit from smaller gauge vitrectomy repair of DM-TRD
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.