Visual Prognosis and Surgical Strategy of Bilateral Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

Abstract

Purpose This study aimed to analyze the visual outcome in patients with proliferative diabetic retinopathy (PDR) undergoing bilateral pars plana vitrectomy (PPV) to propose an effective surgical strategy. Methods This was a retrospective design of 27 patients (54 eyes) with PDR who underwent bilateral PPV. Univariate and multivariate linear regression analyzed factors affect best-corrected visual acuity (BCVA). Differences between the superior and inferior final BCVA groups were compared using t-tests and chi-squared tests. Results The mean BCVA from 1.85 ± 0.94 Log MAR preoperatively improved to 0.76 ± 0.95 Log MAR at the final follow-up (P < 0.001). The final BCVA was significantly better in male patients than female patients (coefficient = -0.546, 95% CI: -1.048 to -0.044, P = .033), better in the first surgery eye than in the second (coefficient = 0.530, 95% CI: 0.030 to 1.030, P = .038), worse with postoperative neovascular glaucoma (NVG) (coefficient = 0.614, 95% CI: 0.045 to 1.184, P = .035). Fibrinogen (FIB) levels were negatively correlated with the final BCVA (coefficient = 0.723, 95% CI: 0.295 to 1.152, P = .001). Shorter surgical time was positively associated with the final BCVA (P = .040). Conclusion This study suggests that a formulated surgical strategy, including rational selection of the first surgery eye, shorter surgery time, prevention of NVG, and reduction of FIB levels, can significantly improve visual prognosis for patients with PDR undergoing PPV.