Is Chronic Kidney Disease Affecting the Postoperative Complications of Vitrectomy for Proliferative Diabetic Retinopathy?

Abstract

Chronic kidney disease (CKD) is a well-known risk factor for postoperative complications in several surgical fields. However, although prevalent among diabetic candidates for vitrectomy, the effect of CKD on vitrectomy outcomes remains unclear. This study aimed at clarifying the relationship between CKD and the occurrence of vitrectomy-related complications in patients with proliferative diabetic retinopathy (PDR). The 6-month incidences of vitreous hemorrhage (VH) and neovascular glaucoma (NVG) following vitrectomy for PDR were compared among the following groups: stages 1–2 CKD (60 patients), stages 3–5 CKD (70 patients not on hemodialysis), and hemodialysis (HD; 30 patients). We also determined whether the deterioration of the estimated glomerular filtration rate (eGFR) was associated with post-vitrectomy events. The incidence of VH was significantly higher in the stages 3–5 CKD group (43%) than in the stages 1–2 CKD (10%) and HD (10%) groups. NVG was more common in the stages 3–5 CKD group (17%) than in the stages 1–2 CKD (2%) and HD (0%) groups. The reduced estimated glomerular filtration rate (eGFR) was the only significant variable associated with post-vitrectomy VH and NVG. Patients with PDR and CKD, particularly those with lower eGFR, might be at risk for post-vitrectomy VH and NVG.

Prophylactic intravitreal injection of aflibercept for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy: A randomized controlled trial

“…The incidence of postoperative VH in PDR had been reported to be around 75% in the 1980s ( 1 , 2 ), but with the development of surgical techniques and instruments, it has decreased to 12–40% in recent years. The risk factors of postoperative VH include younger age, later detection of DM, poor diabetic and hypertension control, higher serum creatinine, broader area of active neovascularization, increased extent of membrane peeling, postoperative hypotony, postoperative residual neovascularization membrane, unrelieved vitreous retinal contraction, and insufficient PRP ( 23 , 24 ). In this study, baseline characters, including age, duration of DM, HbA1c, and patient proportion with renal dysfunction, were compared between the two groups, and vitrectomies were all performed by skillful surgeons with more than 15 years of experience to minimize the selective bias and heterogeneity in surgery.…”

Prospective Comparison of Surgery Outcome Between Preoperative and Intraoperative Intravitreal Injection of Ranibizumab for Vitrectomy in Proliferative Diabetic Retinopathy Patients

“…Postoperative VH, which had been reported to happen in 12-40% vitrectomized PDR patients, will hinder monitoring of disease course and require additional application of laser treatment, therefore delaying visual rehabilitation. The risk factors of postoperative VH include younger age, later detection of DM, poor diabetic and hypertension control, higher serum creatinine, broader area of active neovascularization, increased extent of membrane peeling, postoperative hypotony, postoperative residual neovascularization membrane, unrelieved vitreous retinal contraction and insufficient PRP [28,29]. PRP plays a protective role in disease progression and surgical difficulty of PDR [30].…”

Characteristics of proliferative diabetic retinopathy patients with postoperative vitreous hemorrhage after small-gauge vitrectomy

“…[14] In the early era of 20-gauge vitrectomy, the in uence of continuing anticoagulation or antiplatelet medicine was suggested to be related to POVH [12,35,36]. In recent studies of small-gauge diabetic vitrectomy, most evidence supports that the continued use of anticoagulation or antiplatelet medication in the perivitrectomy period does not increase the chance of POVH [13,14,17,19,32,37]. Consistent with previous reports, we found that the occurrence of POVH was not signi cantly different between patients for whom anticoagulation or antiplatelet medications were continued (0/22) and patients for whom adjustments were made (11/198).…”

“…Previous non-ocular surgery data show that patients with end-stage renal failure are prone to developing postoperative bleeding [41]. In contrast, the data on vitrectomy in renal failure patients showed a contrary result: renal failure and hemodialysis, including heparin dialysis, do not appear to have a deteriorative in uence on the outcomes of diabetic vitrectomy [18,37,42,43]. Our results agree with the previous vitrectomy data; the occurrence of POVH was not different either between patients on dialysis (12) and patients not on dialysis (108) or between patients on heparin dialysis (5,7) and patients on non-heparin dialysis.…”