Abstract
Purpose :
To determine the outcomes of patients undergoing pars plana vitrectomy (PPV) surgery for complications of proliferative diabetic retinopathy (PDR).
Methods :
Retrospective consecutive observational chart review of 933 eyes for 732 patients that underwent PPV for complications of PDR at a large county hospital in Dallas Texas from 2014 to 2019. Outcome measures included single surgery reattachment success rate, best-corrected visual acuity (BVCA), and prevalence of post operative complications. Patients with less than 6 months of follow-up were excluded.
Results :
Patients were 54.5% male and 44.5% female with an average age of 52 years (SD ± 9.5). The average A1c at the time of surgery was 8.36 (SD ± 2.0). There was no correlation between presenting A1c and final BCVA, r-squared =0.001. Also, there was no significant difference in A1c in patients presenting with and without TRD (8.45 vs. 8.23; p=0.19).
PPV surgery was performed for tractional retinal detachment (TRD) involving the macula in 313 eyes (33.5%), non-clearing vitreous hemorrhage in 342 eyes (36.7%), TRD not involving the macula in 125 eyes (13.4%), TRD with unclear macular status in 84 eyes (9.0%), combined TRD and rhegmatogenous retinal detachment in 65 eyes (7.0%), and vitreomacular interface abnormalities in 65 eyes (7.0%).
Average logMAR visual acuity was 1.68 (SD ± 0.74) pre-operatively and 1.04 (SD ± 0.87) at 6 mos post-op. 85.0% of TRD patients had single surgery reattachment success at most recent follow up. Common post-op complications within 6 mos included vitreous hemorrhage (VH) in 497 eyes (53%) and cataracts in 464 eyes (49.7%).
The average final logMAR for patients presenting for surgery for VH and TRD was 0.63 and 1.55 respectively (p<0.001). Among TRD patients, the most recent average logMAR with macula-on TRD was 0.71 versus 1.13 for macula-off TRD (p<0.001). Also, TRD patients who had PRP prior to surgery were less likely to experience VH 6 months post-op: 39% with PRP prior to surgery experienced VH at 6 months versus 51% (p =0.003).
Conclusions :
Vitrectomy is an effective procedure in improving vision and stabilizing the retina in those with complications from PDR. In this study, worse presenting A1c was not correlated with worse visual outcomes or ocular presentation severity. However, more severe ocular presentation correlated with a lower post operative BCVA.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.