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
Specialty: Ophthalmology, Endocrinology