Clinical Characteristics and Surgical Outcomes of Patients Undergoing Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

• Published in: Ophthalmology retina
• Main Authors: Alshaikhsalama, Ahmed M, Thompson, Krista N, Patrick, Hank, Lee, Jessica, Voor, Tamara A, Wang, Angeline L
• Format: Journal Article
• Language: English
• Published: United States 01.08.2024
• ISSN: 2468-6530
• DOI: 10.1016/j.oret.2024.02.015

To evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy (PDR). Retrospective consecutive observational case series of patients at a large county hospital in Dallas, TX, from 2014-2019. 732 patients (933 eyes) undergoing PPV for PDR complications METHODS: Collected data included demographics, surgical indication, adjuvant therapies, intra-operative course, complications, and best corrected visual acuity (BCVA). Patients with less than 6 months of follow-up were excluded. BCVA was converted to logMAR for analysis. Statistics performed included t-test, analysis of variance (ANOVA), and multivariate analyses. Post-operative BCVA, primary anatomic success rate, and post-operative complications. 393 patients were male (509 eyes, 54.5%) with an average age of 52 years. Post-operative BCVA at 6 months was significantly different among surgical indications: 0.79 vs. 0.77 vs. 1.20 (p<0.0001) for vitreous hemorrhage (VH), vitreomacular interface abnormalities (VMI), and tractional retinal detachment (TRD), respectively. Adjuvant pre-operative therapy with panretinal photocoagulation (PRP) vs. no PRP (0.95 vs. 1.25; P<0.001) and insulin vs. no insulin (0.99 vs. 1.17; p<0.01) were associated with improved vision. Iatrogenic breaks were associated with decreased post-operative vision (1.40 vs. 0.88; p<0.001). The primary anatomic success rate for TRD was 85% (495 eyes). Combined TRD/RRD (tractional and rhegmatogenous retinal detachment) was associated with a lower success rate compared to macula-on/macula-off TRD with odds ratios of 0.36, 0.46, and 0.53 respectively. Patients experiencing recurrent detachment post-surgery had worse pre-operative visual acuity (1.93 vs. 1.63; p<0.01) and were younger (47.6 vs. 50.0; p=0.02). Post-operative complications occurred in 699 eyes (75%), with VH (498 eyes, 53%), cataract (465, 50%), and elevated IOP (149, 16%) being the most common. 236 eyes (25%) required a second PPV operation. Endophthalmitis (1 eye, <1%) and choroidal detachment (5 eyes, <1%) were rare. In this retrospective series analyzing surgical outcomes among patients with complications from PDR, vitrectomy led to improved vision on average, with a meaningful proportion of patients receiving additional surgical intervention. Surgical indication, presenting visual acuity, age, and adjuvant therapies appeared to impact outcomes.