Effects of posterior vitreous detachment status on visual and anatomic outcomes after diabetic vitrectomy
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PURPOSE: This study examined the surgical outcomes after pars plana vitrectomy in patients with proliferative diabetic retinopathy at various stages of posterior vitreous detachment. The investigation assessed the changes in visual acuity and the frequency of complications associated with each stage of detachment. METHODS: This retrospective, single-site, single-surgeon study reviewed 328 medical records of patients at Beth Israel Deaconess Medical Center (Boston, MA) requiring pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy between 2000 and 2017. The 328 patients were separated into 4 groups based on their vitreous status (Stages 0 and 1, Stage 2, Stage 3, and Stage 4). Preoperative characteristics were collected, including best-corrected visual acuity (BCVA) and diabetes duration. Complications, visual acuity, and reoperation data were collected postoperatively. RESULTS: Sixty-one percent of the patients in the combined group (Stages 0 and 1), 56% in Stage 2, 67% in Stage 3, and 77% in Stage 4 did not require a revision PPV. Thirteen percent of the patients in the combined group, 13% in Stage 2, 5% in Stage 3, and 0% in Stage 4 required a revision PPV for retinal detachment. This represented a statistically significant difference between the groups (p = 0.0254). The combined group had a postoperative change in BCVA of 0.31 compared with 0.29 for Stage 2, 0.67 for Stage 3, and 0.90 for Stage 4. These BCVA changes represented a statistically significant difference (p = 0.0001) between the groups. CONCLUSIONS: This study shows that having a preoperative posterior vitreous detachment leads to improved visual acuity postoperatively and decreased chance of developing a postoperative retinal detachment. The study also indicates that increased vitreoretinal traction results in less change in visual acuity and an increase in complications. Further research is needed to validate these findings.