Abstract
Purpose :
To review outcomes of patients with proliferative diabetic retinopathy (PDR) who received pars plana vitrectomy (PPV) with endolaser panretinal photocoagulation (PRP).
Methods :
Retrospective chart review study that included patients who underwent PPV with endolaser PRP between June 1, 2010 to May 31, 2020.
Results :
PPV with PRP was performed in 287 eyes of 250 patients. Two hundred forty-six (85.7%) eyes had preoperative vitreous hemorrhage (VH) and 114 (39.7%) eyes had preoperative retinal detachment (RD). Mean preoperative best-corrected visual acuity (BCVA) was 20/781. Mean postoperative BCVAs were 20/150, 20/142, 20/150, 20/136, and 20/142 at 3 months, 6 months, 12 months, 2 years, and 3 years, respectively (P < 0.001). Postoperative complications included VH (18.1%), RD (12.5%), cataract (31.6%), macular hole (2.1%), and endophthalmitis (1.0%). There were negative correlations between age and BCVA at 12 months (r = -0.27, P = 0.002), 2 years (r = -0.28, P = 0.007), and 3 years (r = -0.28, P = 0.009) postoperatively. Individuals with hypertension had worse visual acuity than individuals without hypertension at 3 months (P = 0.02), 6 months (P < 0.001), and 12 months postoperatively (P < 0.001). Individuals with hypertension were also more likely to undergo an additional PPV than individuals without hypertension (P = 0.002). Eyes with traction on ultrasound had a greater frequency of postoperative VH (P < 0.001), cataract (P < 0.001), and need for additional PPV (P = 0.001) and PRP (P < 0.001) compared to eyes without traction. Patients with type 2 diabetes had superior postoperative BCVA at 2 years (P = 0.004) and 3 years (P = 0.02) compared to patients with type 1 diabetes. Preoperative PRP, anti-vascular endothelial growth factor, aspirin, warfarin, and clopidogrel therapy were not associated with superior postoperative visual acuity or reduced rates of postoperative complications including VH (P > 0.05). There were no relationships between postoperative BCVA and hemoglobin A1c, duration of diabetes, duration of PDR, smoking history, hemodialysis status, or insulin dependence (P > 0.05).
Conclusions :
PPV with PRP yields significant improvements in visual acuity. Certain factors including diabetes type, hypertension, age, and preoperative exam findings may affect postoperative outcomes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.