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

Abstract

ObjectiveTo evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy (PDR). DesignRetrospective consecutive observational case series of patients at a large county hospital in Dallas, TX, from 2014-2019. Subjects732 patients (933 eyes) undergoing PPV for PDR complications MethodsCollected data included demographics, surgical indication, adjuvant therapies, intra-operative course, complications, and best corrected visual acuity (BCVA). Patients with less than 6 months of follow-up were excluded. BCVA was converted to logMAR for analysis. Statistics performed included t-test, analysis of variance (ANOVA), and multivariate analyses. Main Outcome MeasuresPost-operative BCVA, primary anatomic success rate, and post-operative complications. Results393 patients were male (509 eyes, 54.5%) with an average age of 52 years. Post-operative BCVA at 6 months was significantly different among surgical indications: 0.79 vs. 0.77 vs. 1.20 (p<0.0001) for vitreous hemorrhage (VH), vitreomacular interface abnormalities (VMI), and tractional retinal detachment (TRD), respectively. Adjuvant pre-operative therapy with panretinal photocoagulation (PRP) vs. no PRP (0.95 vs. 1.25; P<0.001) and insulin vs. no insulin (0.99 vs. 1.17; p<0.01) were associated with improved vision. Iatrogenic breaks were associated with decreased post-operative 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 to macula-on/macula-off TRD with odds ratios of 0.36, 0.46, and 0.53 respectively. Patients experiencing recurrent detachment post-surgery had worse pre-operative visual acuity (1.93 vs. 1.63; p<0.01) and were younger (47.6 vs. 50.0; p=0.02).Post-operative complications occurred in 699 eyes (75%), with VH (498 eyes, 53%), cataract (465, 50%), and elevated IOP (149, 16%) being the most common. 236 eyes (25%) required a second PPV operation. Endophthalmitis (1 eye, <1%) and choroidal detachment (5 eyes, <1%) were rare. ConclusionsIn 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 visual acuity, age, and adjuvant therapies appeared to impact outcomes.