Clinical features and surgical outcomes of complications of proliferative diabetic retinopathy in young adults with type 1 diabetes mellitus versus type 2 diabetes mellitus - A comparative observational study

Abstract

Purpose: To evaluate the clinical profile, visual outcomes, and complications among young adult patients with type 1 diabetes mellitus (insulin-dependent DM-T1DM) in comparison with patients with type 2 diabetes mellitus (T2DM) undergoing vitrectomy for complications of proliferative diabetic retinopathy (PDR). Methods: A retrospective review of patients between 18 and 45 years with T1DM undergoing vitrectomy for complications of PDR between June 2017 and June 2019, with a minimum follow-up of 12 months. Consecutive patients between 30 and 45 years with type 2 diabetes (non-insulin-dependent DM-T2DM) who underwent vitrectomy for the same indications were retrospectively enrolled as the control group. Results: There were 42 eyes (28 patients) in the T1DM group and 58 eyes (47 patients) in the T2DM group. The average age at operation was 35.9 ± 6.88 years and 39.8 ± 3.03 years, respectively ( P < 0.001). At the end of follow-up, the mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) improved from 1.53 ± 0.55 to 1.30 ± 0.93 ( P value 0.07) in the T1DM group and from 1.59 ± 0.46 to 1.00 ± 0.78 in the T2DM group ( P = 0.0001). The rate of the primary and final reattachment was 76.2% and 88.1% in the T1DM group and 84.5% and 96.6% in the T2DM group. Preoperative macular tractional retinal detachment (MTRD) and neovascular glaucoma (NVG) in both the groups, chronic kidney disease (CKD) and lack of preoperative Pan retinal photocoagulation (PRP) in the T1DM group, hypertension (HTN) and, resurgery in the T2DM group, were risk factors for poor vision at the final follow-up. Conclusion: The visual and anatomic outcomes were poorer in the T1DM patients which could be due to the longer duration of diabetes with worse glycemic control, associated comorbidities like CKD, and a higher incidence of MTRD.

Functional and structural outcomes and complications after pars plana vitrectomy for severe features of proliferative diabetic retinopathy in type 1 and type 2 diabetes mellitus

“…The course of diabetes mellitus may rapidly change with progression of diabetic complications if other general disorders, namely systolic hypertension, hyperlipidaemia, obesity or microalbuminuria, occur. It was reported that the prevalence of chronic kidney disease is higher in type 1 DM patients and young diabetics [ 17 , 19 ]. In patients requiring vitrectomy, renal compromise may be a reason for higher risk of intraoperative and postoperative bleeding, delayed wound healing and an increase in mortality [ 44 ].…”

“…Thanks to advancements in vitrectomy in recent years, the rates of primary reattachment and final attachment of retina after vitrectomy for TRD have increased, ranging from 86.3 to 100% [ 18 , 19 , 32 , 40 , 43 ]. Primary reattachment of retina in our patients was achieved in 88.9% and 95.5% of the eyes from the DM1 and DM2 groups, respectively.…”

“…It is believed to be the reason for poorer visual and anatomic outcomes compared with those with type 2 DM [ 19 ]. There are few studies comparing severe retinal changes due to progressed PDR in type 1 with type 2 diabetic patients [ 17 – 19 ]. In this study we aim to evaluate the functional and structural outcomes and postoperative complications among type 1 and type 2 diabetics treated with vitrectomy for severe features of proliferative diabetic retinopathy.…”

Ginsenoside Rg1 Ameliorates Pancreatic Injuries via the AMPK/mTOR Pathway in vivo and in vitro

“… 5–8 However, the compliance of purely Western medical treatment is poor and easily affects the quality of life of T1DM patients, which makes it difficult for many patients to achieve strict control of blood glucose in daily life, resulting in significant blood glucose fluctuations and multiple complications. 9 , 10 Furthermore, T1DM has been confirmed that it is related to various molecular mechanisms, including autophagy, oxidative stress, inflammation and apoptosis of pancreatic β-cells. 11–13 Yet, though significant advances have been made since the past several decades, the potential therapeutic strategies and the exact molecular mechanisms of T1DM remain to be elucidated.…”

27‑Gauge vitrectomy vs. 25‑gauge vitrectomy in the management of proliferative diabetic retinopathy with preoperative intravitreal injection of conbercept

“…Although panretinal photocoagulation (PRP) has been the treatment of choice for delaying the diabetic retinopathy process and preventing visual loss, there remains a high number of patients progressing to the advanced stages, such as vitreous hemorrhage and tractional retinal detachment, and subsequently requiring pars plana vitrectomy (PPV) to clear vitreous haemorrhage (VH) and reattach the retina. However, PPV for patients with PDR can often be challenging ( 2 ). Vitreous removal, membrane peeling and membrane delamination can be difficult procedures due to the tight adhesions formed between the fibrovascular membrane and the retina, which can lead to intraoperative haemorrhages and iatrogenic breaks ( 3 ).…”