Visual Outcomes post-PPV for Tractional Retinal Detachment or Vitreous Hemorrhage in the Intelligent Research in Sight (IRIS) Registry

Abstract

Purpose : Patients with active Proliferative Diabetic Retinopathy (PDR) who develop non-clearing vitreous hemorrhage (VH) and macula-involving tractional retinal detachment (TRD) often undergo surgery with pars-plana vitrectomy (PPV). Our understanding of their visual prognoses remains limited. The purpose of this study was to determine visual acuity outcomes after PPV for TRD and VH patients in the IRIS Registry.

Methods : Patients were identified in the IRIS registry who received a new diagnosis of PDR who then developed either VH or TRD and underwent PPV within 90 days. The distribution of visual acuity in logMAR was evaluated at time points three months pre-PPV to one-year post-PPV, and the difference in mean logMAR one-year post-PPV was compared to one-week pre-PPV with an independent t-test. We further stratified by pseudophakic and phakic patients.

Results : Between 2016 and 2018, 1851 PDR eyes who developed VH underwent PPV and 553 with TRD underwent PPV. 18.8 % of VH eyes were pseudophakic preoperatively compared with 19.2% of TRD eyes, compared with 36.4% and 39.4% after one year post PPV. For TRD, preoperative visual acuity was 1.62 (phakic) and 1.59 (pseudophakic) logMAR and one-year postoperative VA was 1.35 and 1.35, and the difference was not significant (p=0.189 and p=0.260). For VH, preoperative visual acuity was 1.65 (phakic) and 1.73 (pseudophakic) logMAR and one-year postoperative VA was 0.84 and 0.83, and the difference was not significant (p=0.001 and p=0.001). On average, phakic eyes gained 0.82 logMAR and pseudophakic eyes gained 0.89 logMAR. Of note, for VH, the vast majority of improvement came within the first postoperative month.

Conclusions : Patients with PDR who developed TRD and underwent PPV on average presented legally blind (1.62 and 1.59 for phakic and pseudophakic) and did not significantly improve one year after PPV (1.35 and 1.35). Patients with PDR who developed VH and underwent PPV on average presented legally blind (1.66 and 1.73 for phakic and pseudophakic eyes) and improved significantly to 0.84 and 0.83 logMAR after one year, with the vast majority of improvement coming in the first month (1.06 and 1.13). For both TRD and VH, 1 week preoperative and 12 month postoperative VA was not significantly different between phakic and pseudophakic patients, and TRD and VH underwent post-PPV cataract surgery at similar rates.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.