Prognosis value of Chinese Ocular Fundus Diseases Society classification for proliferative diabetic retinopathy on postoperative visual acuity after pars plana vitrectomy in type 2 diabetes

Abstract

AIM: To compare the postoperative visual acuity among eyes with proliferative diabetic retinopathy (PDR) of different stages after pars plana vitrectomy (PPV) in type 2 diabetic patients. METHODS: A retrospective study was conducted for PDR eyes undergoing PPV in type 2 diabetic patients. All patients were divided into three groups based on Chinese Ocular Fundus Diseases Society (COFDS) classification for PDR: Group A (primary vitreous hemorrhage), Group B (primary fibrovascular proliferation) and Group C (primary vitreous hemorrhage and/or fibrovascular proliferative combined with retinal detachment). The postoperative visual acuity and the change between postoperative and preoperative visual acuity were compared among three groups. The associated risk factors for postoperative visual acuity were analyzed in the univariate and multiple linear aggression. RESULTS: In total, 195 eyes of 195 patients were collected in this study, including 71 eyes of 71 patients in Group A, 75 eyes of 75 patients in Group B and 49 eyes of 49 patients in Group C. The eyes in Group A got better postoperative best-corrected visual acuity (BCVA) compared to the eyes in Group B and C (0.48±0.48 vs 0.89±0.63, P<0.001; 0.48±0.48 vs 1.04±0.67, P<0.001; respectively). The eyes in Group A got more improvement of BCVA compared to the eyes in Group B and C (1.07±0.70 vs 0.73±0.68, P=0.004; 1.07±0.70 vs 0.77±0.78, P=0.024; respectively). In the multiple linear regression analysis, primary fibro-proliferative type (β=0.194, 95%CI=0.060-0.447, P=0.01), retinal detachment type (β=0.244, 95%CI=0.132-0.579, P=0.02), baseline logMAR BCVA (β=0.192, 95%CI=0.068-0.345, P=0.004), silicone oil tamponade (β=0.272, 95%CI=0.173-0.528, P<0.001) was positively correlated with postoperative logMAR BCVA. Eyes undergoing phacovitrectomy had better postoperative BCVA (β=-0.144, 95%CI=-0.389 to -0.027, P=0.025). CONCLUSION: PDR eyes of primary vitreous hemorrhage type usually have better visual acuity prognosis compared to primary fibrovascular proliferation type and retinal detachment type. COFDS classification for PDR may have a high prognostic value for postoperative visual outcome and surgical management indications.

Comparison of anterior segment parameters of the eye between type 2 diabetic with and without diabetic retinopathy and non-diabetic

“…Also, only ACD and ACV had a weak negative correlation with HbA1c levels. Similar to our results, other studies show no association between CCT and HbA1c levels [32,[51][52] . In addition, studies found that HbA1c levels do not affect curvature, CV, and corneal asphericity [33,35,53] .…”

“…In agreement, Inoue et al [20] reported that in patients with type 2 DM the corneal endothelium is damaged, the density of endothelial cells decreases, and the coefficient of variation of the cell area increases, but CCT does not increase in them. Lin et al [32] in a hospital-based study reported that CCT was higher in diabetic subjects but this difference is not significant. In another study, 200 diabetic patients with 200 non-diabetic individuals were evaluated.…”

“…Ramm et al [43] found negative correlation between optical density and stage of diabetic retinopathy. Lin et al [32] did not find any significant correlation between HbA1c levels and severity of DR. Senćanić et al [54] found no difference in CCT between diabetic subjects without DR and with NPDR, but CCT was thicker in those with PDR than in those without DR. In contrast, other studies reported that the light corneal optical density increased with each progressive stage of DR [42] .…”

Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage

“…Consequently, conbercept has garnered widespread usage in the treatment of DR in China. At present, doctors tend to lean towards PPV as the preferred option for HR-PDR patients presenting with vitreous hemorrhage (VH) [16,[27][28] . Although PPV can preserve some degree of vision, it is accompanied by risks, being a procedure that is both invasive and costly.…”

Levels of asymmetric dimethylarginine in plasma and aqueous humor: a key risk factor for the severity of fibrovascular proliferation in proliferative diabetic retinopathy

“…The prognosis of patients with PDR can vary due to the extent of fibrovascular proliferation (FVP) in the fundus. PDR with severe FVP often leads to retinal detachment, while PDR patients with simple vitreous hemorrhage generally have a better prognosis than those with retinal detachment due to severe FVP ( 3 , 4 ). Moreover, young patients with PDR are more susceptible to severe FVP, resulting in a poorer visual prognosis ( 5 ).…”