Long‐term results, prognostic factors and cataract surgery after diabetic vitrectomy: a 10‐year follow‐up study

Abstract

ABSTRACT.Purpose: To report long-term results, prognostic factors and cataract surgery after diabetic vitrectomy. Methods: Retrospective review of patient files from a large diabetes centre between 1996 and 2010. Surgical history was obtained from the Danish National Patient Register. Follow-up intervals were 3 months and 1, 3, 5 and 10 years after surgery. Results: In total, 167 patients had diabetic vitrectomy indicated for non-clearing vitreous haemorrhage (47%) and tractional retinal detachment (53%). The proportion of patients with visual acuity ≥0.3 increased from 29% before surgery to 60% after 3 months (p < 0.001, chi-square test). Median visual acuity increased from 0.06 before surgery to 0.3 after 3 months (p < 0.001, paired signed-rank test) and 0.4 after 1 year (p = 0.009) before stabilizing. No significant long-term prognostic factors were identified for non-clearing vitreous haemorrhage patients. For tractional retinal detachment patients, use of silicone oil was associated with low vision (visual acuity<0.3) after 3 months and 1, 3 and 5 years (all odds ratios >4 and p-values ≤ 0.03, logistic regression). Of the 134 patients who were phakic after surgery, 43% and 29% were phakic after 5 and 10 years, respectively. Use of silicone oil increased the risk of cataract surgery (p = 0.009, log-rank test). Conclusions: Most diabetic vitrectomy patients stand to gain visual acuity ≥0.3 after surgery and a stable long-term visual acuity after 1 year. The only consistent long-term predictor of low vision after surgery is use of silicone oil for endotamponade. About 2/3 of phakic patients will subsequently have cataract surgery the first 10 years after diabetic vitrectomy.

The Royal College of Ophthalmologists’ National Ophthalmology Database Study of Vitreoretinal Surgery

“…Silicone oil was used in approximately 6% of cases, similar to some studies 11,12 but lower than the 23% rate reported by Ostri et al 13 Despite the higher tear rate in the delamination group, the postoperative retinal detachment rate was acceptable (2% in both groups), consistent with previous series (eTable in the Supplement). [11][12][13] Our VA analysis should be considered exploratory because, unlike the surgical complication data, VA data collection was not mandated, and not all hospitals used EMRs to record postoperative VA. Overall, 63% of eyes improved by at least 0.3 logMAR (approximately 2 Snellen lines) after surgery, with little difference between the eyes that underwent PPV with delamination and the eyes that underwent PPV without delamination.…”

Postoperative endophthalmitis in Danish eye clinics

“…We agree with Baun that the NPR currently is not a valid data source to monitor the PE risk, but this is largely due to non-compliance with the registration requirements mandated by law and to a much lesser degree with enjoyed reading the work of Ostri et al (2013) on long-term followup of patients with diabetic vitrectomy. The findings on cataract surgery are interesting, and I think some of my own data can add to the discussion regarding the requirement of cataract surgery, in particular, the effect of age and gas tamponade use on the development of cataract in this group of patients.…”

An optical coherence tomography study of residual subfoveal fluid after successful pars plana vitrectomy in patients with diabetic tractional macular detachment

“…Tractional macular detachment remains one of the severe complications of PDR, and, even with successful surgery, visual recovery is often slow and may even take 1 year [10,22]. OCT imaging of the macular area can provide considerable help in explaining the mechanisms behind delayed functional recovery.…”

“…The results of surgical management of macula-off TRD depend on many factors, such as duration of macular detachment, timing of surgery, and extent of macular ischemia [8][9][10].…”