Abstract
Purpose :
Severe vision-threatening, neovascular complications of proliferative diabetic retinopathy (PDR) often require surgical treatment with pars plana vitrectomy (PPV). We aimed to identify and better understand the individual and systems-based risk factors for PPV among patients with PDR in a diverse, urban safety-net hospital setting.
Methods :
This single center, retrospective, case-control study at Zuckerberg San Francisco General Hospital and Trauma Center included 222 patients with PDR over a 5-year span (2017-2022), consisting of 111 cases who underwent PPV for neovascular complications (tractional retinal detachment, non-clearing vitreous hemorrhage, or neovascular glaucoma) and 111 controls with PDR and no history of PPV. Risk for complications requiring PPV among 18 individual variables and 11 systems-based factors was assessed using multivariable logistic regression.
Results :
The absence of panretinal photocoagulation was the primary individual-focused risk factor for PPV among patients with PDR in the multivariable analysis (OR 4.78, p=0.011). Longer intervals (in weeks) between PDR diagnosis and initial treatment (OR 1.06, p=0.024) as well as greater cumulative duration (in months) of loss-to-follow-up during intervals of active PDR (OR 1.10, p=0.002) were identified as systems-focused risk factors in the multivariable analysis, whereas greater duration (in years) in the ophthalmology system was found to be protective (OR 0.75, p=0.035). Univariable, but not multivariable, analysis also found increased odds among PDR patients of younger age (p<0.001), worse visual acuity (p<0.001), Medi-Cal insurance (p=0.003), history of homelessness (p=0.004), and acute route of referral (p<0.001).
Conclusions :
Risk for complications requiring PPV among PDR patients may be modulated by a combination of individual and systems-based factors. Panretinal photocoagulation status, initial PDR treatment naïve interval, active PDR loss-to-follow-up, and time in the ophthalmology system were found to most impact odds for diabetic PPV in the urban safety-net hospital setting. Each additional month of loss-to-follow-up for patients with active PDR increased the odds of PPV by 10%. Optimizing modifiable systems-based factors to promote earlier treatment of PDR and maintain follow up after conversion to PDR may offer opportunities for patients to achieve better visual outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.