Vitrectomy in diabetic patients with a blind fellow eye

Abstract

Results of pars plana vitrectomy for complications of proliferative diabetic retinopathy were analysed in 32 consecutive patients with a blind fellow eye due to diabetic eye disease. The mean follow-up period was 22.3 months. Only 16% of all eyes examined had received full scatter photocoagulation prior to referral for vitrectomy. Out of 9 eyes with vitreous haemorrhage, 8 improved to a visual acuity of > or = 0.2 postoperatively. Amid 23 eyes which were vitrectomized for advanced traction retinal detachment, only 4 eyes improved to a postoperative visual acuity of > or = 0.02. In this group 12 eyes deteriorated after vitrectomy, 3 eyes progressing to no light perception. The postoperative visual outcome after vitrectomy for traction retinal detachment in this group of diabetics with a blind fellow eye (mean postoperative visual acuity 0.03 +/- 0.05) was significantly worse (p < 0.000) compared to a group of 196 patients with a seeing fellow eye who were vitrectomized for traction retinal detachment at our clinic (mean postoperative visual acuity 0.09 +/- 0.11). Therefore we conclude that traction retinal detachment in this subgroup of patients is a particularly severe presentation of diabetic retinopathy with a guarded functional prognosis after vitrectomy. Our results demonstrate the importance of timely full scatter photocoagulation and early vitrectomy in eyes with progressive fibrovascular proliferation not responding to panretinal photocoagulation. We conclude that especially diabetic patients with a blind fellow eye must be followed closely and assigned to vitrectomy at an earlier stage of their disease in order to improve functional prognosis.

Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy

“…Other authors have reported that blindness in the contralateral eye is associated with a poor prognosis,7 and our results confirm that poor vision in the contralateral eye increases the risk of a poor visual outcome. However, of the 44 eyes in which the contralateral eye had a vision of counting fingers or less, 26 (59%) achieved a vision of 6/60 or better.…”

Pathogenesis and Classification of Proliferative Diabetic Vitreoretinopathy

“…As the vitreous has a defined role in the pathogenesis of PDVR, vitreous removal, either by pars plana vitrectomy [13, 33, 56, 74, 95 ]or by enzymatic means [52, 53],is an appropriate technique to interrupt this process and to prevent final stages. Various studies have demonstrated that vitrectomy earlier in the course of the disease prevents the onset of severe complications [50, 101].…”

Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature

“…But despite advancements in vitrectomy, visual outcomes in eyes with advanced abnormality are less than optimal with 3-34% experiencing VA loss, 7-22% experiencing anatomic failure and a 29-37% incidence of iatrogenic breaks in eyes with TRD [20,21]. Vitrectomy on eyes with advanced disease and a blind fellow eye show decreased VA in 52% of cases, with 13% of them ending with no light perception vision [22]. In the fellow eye study by Vote, 38% required fellow eye surgery within 1.6 years, 14% were monocular, and 17% achieved less than 20/200 VA after surgery [19].…”