The Surgical Outcomes, Complications and Predictive Surgical Factors of Diabetic Retinopathy Vitrectomy in a Large Asian Tertiary Eye Center

Daniel Shu Wei Ting,Gavin Siew Wei Tan,Wei Yan Ng

doi:10.4172/2155-9570.1000494

Daniel Shu Wei Ting, Gavin Siew Wei Tan + Show 1 more

Open Access

https://doi.org/10.4172/2155-9570.1000494

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Abstract

Purpose: To evaluate the visual, anatomical outcomes, complications and the predictive preoperative and intraoperative factors of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) in a large Asian tertiary eye center. Methods: This is a consecutive retrospective review of 106 eyes that underwent PPV for PDR complications in 2013. The functional success was defined as visual acuity of 20/200 or better while the anatomical success was defined as 360° flat retina without endo-tamponade at one year. Results: The overall functional and anatomical success was 77.4% and 94.3%, respectively. The common complications were iatrogenic break (14.2%), raised intraocular pressure (IOP) (13.2%), cataract (13.2%) and recurrent vitreous hemorrhage (12.3%). The use of intraoperative triamcinolone (OR: 0.36, p=0.04) and silicone oil (OR: 0.08, p<0.001) were associated with poorer visual success. The iatrogenic breaks occurred more often in 20G PPV than 23G PPV (OR: 5.89, p=0.02) whereas intraoperative silicone oil were associated with postoperative raised IOP (OR: 3.71, p=0.04). The use of bevacizumab was not found to reduce recurrent vitreous hemorrhage (OR: 0.53, 95%CI: 0.11-2.53, p=0.43). Conclusions: In the era of small gauge vitrectomy, the visual, anatomical outcomes and complication rates of PPV for PDR patients in Singapore had improved significantly, as compared to the Diabetic Retinopathy Vitrectomy Study.

Highlights

Diabetes is a metabolic disease that can result in numerous macrovascular and micro-vascular complications, including diabetic retinopathy (DR)
Since the Diabetic Retinopathy Vitrectomy Study (DRVS) [6], a few studies have shown that the surgical outcomes of diabetic vitrectomy have improved significantly with the preoperative use of anti-vascular endothelial growth factor and intraoperative use of endolaser and microincision vitrectomy surgery [7,8]
The purpose of our study is to evaluate the visual, anatomical outcomes, complications of pars plana vitrectomy (PPV) in proliferative diabetic retinopathy (PDR) patients in a large Asian tertiary eye center and assess if preoperative and intraoperative factors affect these outcomes

Summary

Introduction

Diabetes is a metabolic disease that can result in numerous macrovascular and micro-vascular complications, including diabetic retinopathy (DR). A pooled analysis of 22,896 diabetic patients from 35 population-based studies in the U.S, Australia, Europe and Asia (between 1980-2008) showed that the overall prevalence of any DR (in T1DM and T2DM) was 34.6% (95%CI 34.5-34.8), with 7% (6.9-7.0) VTDR [2]. Since the Diabetic Retinopathy Vitrectomy Study (DRVS) [6], a few studies have shown that the surgical outcomes of diabetic vitrectomy have improved significantly with the preoperative use of anti-vascular endothelial growth factor (anti-VEGF) and intraoperative use of endolaser and microincision vitrectomy surgery [7,8]. There is limited data on the effectiveness of these surgical adjuvants on the outcomes of pars plana vitrectomy (PPV) for complications of PDR patients in Asia

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