Clinical Characteristics and Surgical Outcomes of Patients Undergoing Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

Ahmed M Alshaikhsalama; Krista N Thompson; Hank Patrick; Jessica Lee; Tamara A Voor; Angeline L Wang

doi:10.1016/j.oret.2024.02.015

Clinical Characteristics and Surgical Outcomes of Patients Undergoing Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

Ophthalmol Retina. 2024 Mar 4:S2468-6530(24)00087-3. doi: 10.1016/j.oret.2024.02.015. Online ahead of print.

Authors

Ahmed M Alshaikhsalama¹, Krista N Thompson¹, Hank Patrick¹, Jessica Lee¹, Tamara A Voor¹, Angeline L Wang²

Affiliations

¹ The University of Texas Southwestern Medical Center, Dallas, Texas.
² The University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: angeline.wang@utsouthwestern.edu.

PMID: 38447921
DOI: 10.1016/j.oret.2024.02.015

Abstract

Objective: To evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy (PDR).

Design: Retrospective consecutive observational case series of patients at a large county hospital in Dallas, Texas, from 2014 to 2019.

Subjects: Seven hundred thirty-two patients (933 eyes) undergoing PPV for PDR complications.

Methods: Collected data included demographics, surgical indication, adjuvant therapies, intraoperative course, complications, and best corrected visual acuity (BCVA). Patients with < 6 months of follow-up were excluded. Best corrected visual acuity was converted to logarithm of the minimum angle of resolution for analysis. Statistics performed included t test, analysis of variance, and multivariate analyses.

Main outcome measures: Postoperative BCVA, primary anatomic success rate, and postoperative complications.

Results: Three hundred ninety-three patients were male (509 eyes; 54.5%) with an average age of 52 years. Postoperative BCVA at 6 months was significantly different among surgical indications: 0.79 versus 0.77 versus 1.20 (P < 0.0001) for vitreous hemorrhage (VH), vitreomacular interface abnormalities, and tractional retinal detachment (TRD), respectively. Adjuvant preoperative therapy with panretinal photocoagulation (PRP) versus no PRP (0.95 vs. 1.25; P < 0.001) and insulin versus no insulin (0.99 vs. 1.17; P < 0.01) were associated with improved vision. Iatrogenic breaks were associated with decreased postoperative vision (1.40 vs. 0.88; P < 0.001). The primary anatomic success rate for TRD was 85% (495 eyes). Combined TRD/RRD (tractional and rhegmatogenous retinal detachment) was associated with a lower success rate compared with macula-on/macula-off TRD, with odds ratios of 0.36, 0.46, and 0.53, respectively. Patients experiencing recurrent detachment postsurgery had worse preoperative visual acuity (VA) (1.93 vs. 1.63; P < 0.01) and were younger (47.6 vs. 50.0; P = 0.02). Postoperative complications occurred in 699 eyes (75%), with VH (498 eyes, 53%), cataract (465, 50%), and elevated intraocular pressure (149, 16%) being the most common. Two hundred thirty-six eyes (25%) required a second PPV operation. Endophthalmitis (1 eye; <1%) and choroidal detachment (5 eyes; <1%) were rare.

Conclusions: In this retrospective series analyzing surgical outcomes among patients with complications from PDR, vitrectomy led to improved vision on average, with a meaningful proportion of patients receiving additional surgical intervention. Surgical indication, presenting VA, age, and adjuvant therapies appeared to impact outcomes.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Keywords: Anti-VEGF; Panretinal photocoagulation; Pars plana vitrectomy; Proliferative diabetic retinopathy; Tractional retinal detachment.