Prognostic Indicators of Outcome Following Vitrectomy for Diabetic Retinopathy

The presence of certain prognostic factors is associated with the outcome following pars plana vitrectomy for complications of diabetic retinopathy.

Poor visual outcome:

(1) visual acuity < 5/200

(2) no light perception

Preoperative factors associated with poorer visual outcome (visual acuity < 5/200) include:

(1) preoperative iris neovascularization

(2) cataract

(3) visual acuity < 5/200

(4) traction or rhegmatogenous retinal detachment

Intraoperative factors associated with greater chance of poor visual result include:

(1) use of intravitreal gas or air

(2) creation of an iatrogenic retinal break or detachment

Factors associated with poorer visual outcome in some analyses:

(1) age at time of vitrectomy (40 years of age or older)

(2) use of oral hypoglycemic agents rather than insulin

(3) lensectomy at the time of vitrectomy

Interpretation:

• The presence of any one of the preoperative or intraoperative factors results in a 1.5-3.9 times greater risk of poor final visual result.

Preop Visual Acuity	Preop Iris Neovas-cularization	Preop Cataract	Indication for Vitrectomy	Intraop Lens-ectomy	Probability >= 5/200
>= 20/200	N	N	vit hem	N	0.94
5-15/200	N	N	vit hem	N	0.92
< 5/200	N	N	vit hem	N	0.86
>= 20/200	N	N	trac rd	N	0.84
< 5/200	N	Y	vit hem	N	0.81
5-15/200	N	N	trac rd	N	0.80
< 5/200	N	Y	vit hem	Y	0.73
5-15/200	N	Y	trac rd	N	0.72
< 5/200	N	N	trac rd	N	0.68
5-15/200	N	Y	rheg rd	N	0.66
< 5/200	Y	N	vit hem	N	0.66
< 5/200	N	N	rheg rd	N	0.61
< 5/200	N	N	trac rd	Y	0.59
< 5/200	N	Y	trac rd	N	0.59
< 5/200	N	Y	rheg rd	N	0.51
< 5/200	N	Y	trac rd	Y	0.49
< 5/200	Y	Y	vit hem	Y	0.47
< 5/200	N	Y	rheg rd	Y	0.41
< 5/200	Y	Y	trac rd	Y	0.23
< 5/200	Y	Y	rheg rd	Y	0.18

where:

• vit hem = vitreous hemorrhage

• trac rd = traction retinal detachment

• rheg rd = rhegmatogenous retinal detachment

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