Abstract
Purpose :
To investigate the surgical outcomes and prognostic factors of proliferative diabetic retinopathy (PDR) in young patients.
Methods :
Fifty cases with PDR patients under 40 years old, mean age 35.1 ±3.9 years (group A), who underwent 25G or 27G vitrectomy (minimal invasive vitrectomy; MIVS) between May 2015 and June 2021 at Juntendo University Urayasu Hospital and had been followed up for at least six months, were included in the study. Preoperative systemic factors, ocular findings, surgical techniques, postoperative visual acuity, and complications were investigated retrospectively. The results were also compared with those of 60 eyes with PDR under the same conditions (group B) who underwent 20G vitrectomy between 2005 and 2009.
Results :
The mean follow-up was 30.5±19.4 months. Preoperative visual acuity and systemic factors were similar in groups A and B, but preoperative pan-retinal photocoagulation was performed predominantly in group A. Preoperative anti-VEGF intravitreal injection was used in 30% of patients in group A, but not in group B. In terms of postoperative complications, vitreous hemorrhage was significantly more common in group A (p=0.020); however, there was a significantly greater reduction in the incidence of postoperative neovascular glaucoma (NVG) (p= 0.016). The mean final postoperative logMAR was 0.42±0.68 in group A, and 0.66±0.96 in group B. The final visual acuity in group A improved by 0.2 logMAR or more in 34 eyes (68%) and worsened in seven eyes (14%). In group B, postoperative NVG and systemic factors such as hypertension or overt proteinuria were significant risk factors for poor visual outcomes. Meanwhile, only the recurrence of postoperative proliferative membranes, which leads to proliferative vitreoretinopathy (PVR), was a significant risk factor for poor visual outcomes in group A (p<0.01). Postoperative NVG, which was an independent factor for worsening visual acuity in 23% of patients in group B, was reduced to three eyes (6%) in group A (p=0.016), and no cases of worsening visual acuity were observed.
Conclusions :
MIVS for PDR in young adults may have an improved prognosis owing to the lower incidence of postoperative NVG and improved outcome for NVG itself; however, postoperative PVR remains a significant poor prognostic factor.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.