Black patients sustain vision loss while White and South Asian patients gain vision following delamination or segmentation surgery for tractional complications associated with proliferative diabetic retinopathy

Abstract

PurposeThis retrospective comparative case series aims to determine whether patient ethnicity (White versus South Asian versus Black) is related to the outcome of surgical treatment for traction complications of severe proliferative diabetic retinopathy (PDR).SettingMoorfields Eye Hospital London, UK.MethodsAll patients who underwent vitrectomy with, delamination and/or segmentation for PDR over a 5-year period (2009-2014) were reviewed retrospectively. Patients were divided into White, South Asian or Black groups, and their age, gender, HbA1C and type of diabetes were recorded. A total of 484 patients (253 White, 117 South Asian, 114 Black) were included. Twenty-one patients were excluded due to inadequate documentation.OutcomesLogMAR Visual acuity (converted from Snellen) (VA), was recorded pre-operatively and ~6 months post surgery (range 5-8 months). Surgical outcome was classified according to the type and duration of tamponade required post-operatively.ResultsPre-operative VA and HbA1C values were similar across all three ethnic groups (P=0.64 and 0.569, respectively). Change in VA (mean±SD) was 0.41±0.78, 0.14±0.76 and -0.26±0.57 in White, South Asian and Black patient groups respectively (P<0.001). Multiple regression analysis showed that post-op VA was significantly related to race and pre-op VA only (both P<0.001). The Black patient group were more likely to require silicone oil tamponade (P<0.001) and long-term retention of silicone oil (P<0.001) than the White and South Asian patient groups.ConclusionsThis study demonstrates that Black patients on average lose vision following delamination surgery for traction complications of PDR while White and South Asian patients gain vision. The same group is also at higher risk of retaining silicone more than 6 months after surgery. This difference remains even when corrected for glycaemic control. The higher risk of visual loss and long-term retention of silicone oil in black patients requires further investigation. If these results are confirmed, surgeons should consider their patients' ethnicity before proceeding with surgical treatment of diabetic tractional detachment.

Beneficial visual outcome of vitrectomy and delamination surgery for tractional complications of diabetic retinopathy in a cohort of black patients

“…This is comparable to the visual outcome in the 2016 National Ophthalmic Database report on the outcome of vitrectomy and delamination in the UK in patients of all race/ethnicity [3]. It is however a very different result to that presented by Mastropasqua et al, in which the mean change in acuity in black patients was a loss of virtually 3 logMAR lines [4]. The only other data of which we are aware on the outcome of vitrectomy and delamination in cohorts of black patients were reported by Guthrie et al [8] and Rice & Steffen [9].…”

“…A recent comparative analysis by Mastropasqua et al found that black patients did not benefit from vitrectomy and delamination surgery for tractional complications of proliferative diabetic retinopathy [4]. They reported a mean decline in visual acuity of 0.26 logMAR by 6 months post-operatively.…”

“…Mastropasqua et al [4] have recently reported the results of a retrospective single-centre series of patients undergoing vitrectomy and delamination surgery for tractional complications of proliferative diabetic retinopathy. They found that black patients on average lost more than two logMAR lines, with high rates of both short and long-term silicone oil tamponade being employed.…”

Indications and outcomes of vitrectomy surgery in a series of 1000 black African eyes

“…However a quarter of patients in Guthrie et al ’s study were non-domicile and may represent different ethnicity. Mastropasqua et al have shown that black patients have poorer visual outcomes compared with white and Asian patients, and this may explain our outcomes in an exclusively black population 24. A preoperative intravitreal injection of bevacizumab has been demonstrated by Guthrie et al in an African population to reduce intraoperative complications and reduce vision loss after vitrectomy 23.…”

Remodeling of Retinal Architecture in Diabetic Retinopathy: Disruption of Ocular Physiology and Visual Functions by Inflammatory Gene Products and Pyroptosis

“…However, the exact number and nature of the genes involved or the epigenomics elements that are involved remain elusive. Other demographic risk factors for DR include Hispanic or African American ethnicity, systemic hypertension, duration of disease, and pregnancy ( Gupta and Misra, 2016 ; Penman et al, 2016 ; Varma et al, 2016 ; Davidson, 2017 ; Jin et al, 2017 ; Kowluru, 2017 ; Mastropasqua et al, 2017 ; Zhang et al, 2017 ). DME is one of the most common complications and the cause of vision loss in diabetics.…”