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    Prognostic factors in eyes with severe proliferative diabetic retinopathy managed with pars plana vitrectomy
    (2009) Ünver, Yaprak Banu; Yavuz, Gülderen Aktan; Sinclair Stephen H.
    Purpose: To determine the prognostic factors of functional outcomes in eyes with severe proliferative diabetic retinopathy (PDR) managed with pars plana vitrectomy (PPV). Materials and Methods: A series of 136 consecutive eyes with severe PDR and non-clearing vitreous hemorrhage (VH) or retinal detachment (RD) that underwent PPV were retrospectively reviewed for prognostic risk factors of surgical outcomes and post-operative vision. Chi-square and logistic regression analysis were used for statistical analysis. Results: Average follow-up was 35 months (range 6-56). A functional outcome (VA>5/200) was achieved in 109 eyes (80.1%) and in 51 of 66 eyes (77.3%) with traction retinal detachment. The VA was improved two lines or more in 79 eyes (58.1%), unchanged in 37 (27.2%), and was worse by 2 lines or more in 20 eyes (14.7%). Complete retinal attachment was observed at the final visit in 122 eyes (89.7%). Predictors of a poor visual outcome were found to be preoperative neovascularization severity (p=0.02), presence of iris neovascularization (RI) (p=0.04), absence of prior pan-retinal photocoagulation (p=0.03), intraoperative fluid/gas exchange (p=0.003), iatrogenic retinotomy (p=0.04), postoperative RI (p=0.0001), recurrent VH (p=0.003), RD requiring PPV and/or buckle surgery (p=0.0001). Logistic regression analysis demonsrated that the significant factors responsible for poor functional outcome to be post-operative RI and RD. Conclusion: Vitreoretinal surgery has been demonstrated to preserve and improve vision in eyes with severe proliferative diabetic retinopathy. Counselling of patients who are to undergo surgery can be performed with a better understanding of the risks of major complications and the likely outcomes.