Long‐term outcomes of vitrectomy for proliferative diabetic retinopathy

Abstract

Purpose To investigate the long‐term outcomes of patients who underwent vitrectomy for proliferative diabetic retinopathy. Methods Cumulative incidences were calculated for low vision (<0.3), re‐vitrectomy in the study eye and fellow eye vitrectomy. To identify potential prognostic factors that associate with these outcomes, we used multivariable Cox regression models. Results In a total of 217 patients, we found 1‐, 5‐ and 10‐year cumulative incidences of low vision in the study eye of 24%, 31% and 39%, respectively. For both eyes, these rates were, respectively, 10%, 14% and 14%. Low vision in both eyes was associated with higher age and worse contralateral visual acuity. The 1‐, 5‐ and 10‐year cumulative incidences for re‐vitrectomy in the study eye were 16%, 27% and 27%, respectively, and for a vitrectomy in the fellow eye 24%, 40% and 54%, respectively. Re‐vitrectomy of the study eye was associated with worse contralateral visual acuity, while vitrectomy of the fellow eye was associated with shorter diabetes duration, worse contralateral visual acuity, higher HbA1c level and worse diabetic retinopathy severity stage of the fellow eye. Conclusion Functional visual acuity in at least one eye was achieved or preserved in most patients. After 10 years, about a quarter of all patients underwent a re‐vitrectomy, while more than half of the patients needed a vitrectomy of the fellow eye. Knowledge of these long‐term outcomes is essential when counselling patients for a vitrectomy.

Global trends and performances in diabetic retinopathy studies: A bibliometric analysis

“…However, it is important to be aware of the risk of increased intraocular pressure and cataract progression when using hormonal drugs ( 53 ). Persistent vitreous hemorrhage may require a vitrectomy to preserve functional vision ( 54 ). Blocking the expression of DR-related genes can help prevent neurovascular abnormalities in DR ( 36 , 55 , 56 ) while inducing stem cell differentiation can reshape retinal function ( 57 ).…”

Medical Versus Surgical Management of Proliferative Diabetic Retinopathy: A Review of Current Treatments, Efficacy, Cost-effectiveness, and Compliance-related Outcomes

“…Schreur et al22 reported the long-term outcomes of 217 patients who underwent PPV for PDR and found that over a 10-year follow-up period, the majority of patients retained functional visual acuity in at least 1 eye. During the follow-up period, one-fourth of the vitrectomized eyes required repeat PPV, while over half the fellow eyes required PPV 22.…”

“…Schreur et al22 reported the long-term outcomes of 217 patients who underwent PPV for PDR and found that over a 10-year follow-up period, the majority of patients retained functional visual acuity in at least 1 eye. During the follow-up period, one-fourth of the vitrectomized eyes required repeat PPV, while over half the fellow eyes required PPV 22. Importantly, the primary PPVs in this study were performed for the classic indications, including nonclearing or recurrent vitreous hemorrhage with or without tractional component, neovascular glaucoma unresponsive to laser treatment, or extensive neovascular proliferation unresponsive to laser treatment 22.…”

“…[17][18][19][20][21] Classic indications for PPV in PDR include nonclearing or significant recurrent vitreous hemorrhage, dense premacular subhyaloid hemorrhage, tractional retinal detachment (TRD) involving or threatening the macula, combined tractional/rhegmatogenous retinal detachment, hemolytic and ghost-cell glaucoma, and anterior segment neovascularization with media opacities preventing PRP. 22 However, with the advent of improved surgical techniques including small-gauge vitrectomy, wide-angle viewing systems, intraoperative endolaser, and anti-VEGF adjuvants before surgery, 23 early PPV for PDR has become an increasingly attractive option for certain PDR patients. Removal of vitreous opacities and fibrous membranes and release of areas of vitreous traction through the creation of a posterior vitreous detachment (PVD) prevents tractional or combined tractional/rhegmatogenous retinal detachment, which are the main drivers of vision loss in PDR.…”

“…22 Importantly, the primary PPVs in this study were performed for the classic indications, including nonclearing or recurrent vitreous hemorrhage with or without tractional component, neovascular glaucoma unresponsive to laser treatment, or extensive neovascular proliferation unresponsive to laser treatment. 22 Thus is reasonable to believe that for patients undergoing early PPV as a primary treatment of uncomplicated PDR, the results would likely be even more favorable. Similarly, Liao et al 24 found that PPV for both young and older patients with complex PDR (ie, not PPV as primary treatment) was a safe and effective treatment.…”