Axial length and intraoperative posterior vitreous detachment as predictive factors for surgical outcomes of diabetic vitrectomy

Abstract

Aims To evaluate the relationship of axial length (AXL), intraoperatively assessed posterior vitreous detachment (PVD) status, and surgical outcomes of diabetic vitrectomy. Methods Retrospective, consecutive case series. Clinical records were reviewed for 115 eyes (50 males, 65 females) with more than a 6-month follow-up who underwent diabetic vitrectomy from a single surgeon. Thirty-three eyes had vitreous haemorrhage, 37 had tractional retinal detachment (TRD) threatening the macula, 43 had TRD involving the macula, and two had neovascular glaucoma. AXL was measured preoperatively by ultrasonography, and PVD status was classified intraoperatively: broad vitreo-retinal adhesion as no PVD, PVD at the macular area with attachment at the disc as incomplete PVD, and complete PVD. Results Forty-four eyes had no PVD, 23 had incomplete PVD, and 48 had complete PVD. A majority of the no PVD group had macula off TRD (97.7%), whereas vitreous haemorrhage (68.7%) predominated in the complete PVD group. Longer AXLs were noted in the complete PVD group compared with the no PVD and incomplete PVD groups (ANOVA in three groups P ¼ 0.0001). Univariate analysis showed that AXL had an influence on anatomical success (P ¼ 0.02). Multiple logistic regression analysis yielded that PVD status is a significant predictor of the final best corrected visual acuity (BCVA)420/100, and BCVA420/40 (P ¼ 0.01, P ¼ 0.02). Conclusions Intraoperatively assessed PVD status is a prognostic factor for functional outcomes of diabetic vitrectomy. Shorter AXL was associated with lesser PVD. In eyes with a lack of PVD, careful timing and decision of surgery are mandatory.

Posterior Vitreous Detachment Status as a Predictive Factor for Outcomes of Vitrectomy for Diabetic Vitreous Hemorrhage

“…Previous studies have similarly reported that vitreoretinal adhesion is associated with an increased rate of postoperative TRD and poorer visual outcomes. 10,16 In contrast to these studies, which examined outcomes of vitrectomy for complications of PDR and included a broad range of surgical indications and coexisting ophthalmic diagnoses, our case series included only eyes with the primary diagnosis of NCVH with the aim of accurately identifying the prognostic value of PVD status in this subset of eyes.…”

Effect of axial length and age on the visual outcome of patients with idiopathic epiretinal membrane after pars plana vitrectomy

“…The mechanism of a shorter AL causing worse visual outcomes may be related to the tractional forces at the vitreoretinal interface caused by iERM. A previous study has shown that posterior vitreous detachment (PVD) is less frequently seen in eyes with a shorter AL in diabetic retinopathy patients 37 . Eyes with a shorter AL may have no PVD or macula-sparing PVD, which directly mediates vitreous tractional forces to the macula chronically (Fig.…”

Shorter Axial Length Is a Risk Factor for Proliferative Vitreoretinopathy Grade C in Eyes Unmodified by Surgical Invasion

“…This directly mediates the vitreous tractional force to the retina, and the preoperative tractional force by the iERM and/or the intraoperative tractional force exerted on the retina while peeling the iERM may damage the retinal neurons. Vitreous liquefaction is exacerbated in eyes with a long AL [23], and posterior vitreous detachment (PVD) is seen less frequently in eyes with a shorter AL in patients with diabetic retinopathy [24]. In contrast, PVD develops at a significantly younger age in highly myopic eyes compared to the age-and sex-matched non-highly myopic eyes [25].…”