Rehana Khan1, Janani Surya1, Ramachandran Rajalakshmi2, Padmaja Kumari Rani3, Giridhar Anantharaman4, Mahesh Gopalakrishnan4, Alok Sen5, Abhishek Desai6, Rupak Roy1, Sundaram Natarajan7, Lanin Chen7, Gajendra Chawla8, Umesh Chandra Behera9, Lingam Gopal10, Vinata Muralidharan1, Sobha Sivaprasad11, Rajiv Raman12. 1. Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India. 2. Department of Ophthalmology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India. 3. Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India. 4. Department of Vitreo-Retina, Giridhar Eye Institute, Kochi, India. 5. Department of Retina and Uvea, Sadguru Netra Chikitsalaya, Chitrakoot, India. 6. Department of Vitreo Retinal Services, Shri Ganapati Nethralaya, Jalna, India. 7. Department of Vitreo Retina Surgery, Aditya Jyot Eye Hospital, Mumbai, India. 8. Director, Vision Care & Research Centre, Bhopal, India. 9. Department of Retina and Vitreous Service, LV Prasad Eye Institute, Bhubaneswar, India. 10. Associate Professor, Senior consultant, National University of Singapore, Singapore, Singapore. 11. NIHR Moorfields Biomedical Research Centre, London, United Kingdom. 12. Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India, rajivpgraman@gmail.com.
Abstract
INTRODUCTION: To report the 10-year rate of vitrectomies and the associated factors in people with proliferative diabetic retinopathy (PDR) from a multicentric cohort of people with diabetes mellitus. METHODS: Ten centres in India with established vitreoretinal (VR) services for over 10 years were invited to provide long-term data on PDR. People with Type 1 or 2 diabetes with a clinical diagnosis of active PDR in 1 or both eyes were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, and diabetic retinopathy status in both eyes. Available follow-up data included the numbers of panretinal photocoagulation (PRP) sessions, cataract surgery, treatment of diabetic macular oedema, use of anti-vascular endothelial growth factor (VEGF) therapy, vitrectomy with or without retinal surgeries over 10 years. RESULTS: Over 10 years, 89% needed supplemental PRP after initial complete PRP. One-third required retinal surgery, 16% needed intravitreal injection. Men (74.5%) had significant higher risk for vitreous (VR) surgery. Of the group with low-risk PDR, 56.8% did not require VR surgery, p < 0.001. Of the patients who underwent cataract surgery and had intravitreal anti-VEGF injections, 78.5 and 28.2% needed subsequent vitreous (VR) surgery, p = 0.006 and <0.0001, respectively. Independent predictors of need for vitreoretinal surgery included those who underwent cataract surgery and those with poor baseline visual acuity (logMAR). Eyes at lower risk for VR surgery included the eyes previously treated with PRP and low-risk PDR at baseline. CONCLUSION: Despite initial "complete" PRP, one-third of our study cohort needed vitrectomies over 10 years, highlighting that these patients require regular follow-up for a long period of time.
INTRODUCTION: To report the 10-year rate of vitrectomies and the associated factors in people with proliferative diabetic retinopathy (PDR) from a multicentric cohort of people with diabetes mellitus. METHODS: Ten centres in India with established vitreoretinal (VR) services for over 10 years were invited to provide long-term data on PDR. People with Type 1 or 2 diabetes with a clinical diagnosis of active PDR in 1 or both eyes were included. Baseline data collected included age, sex, duration of diabetes, source of referral and best-corrected visual acuity, and diabetic retinopathy status in both eyes. Available follow-up data included the numbers of panretinal photocoagulation (PRP) sessions, cataract surgery, treatment of diabetic macular oedema, use of anti-vascular endothelial growth factor (VEGF) therapy, vitrectomy with or without retinal surgeries over 10 years. RESULTS: Over 10 years, 89% needed supplemental PRP after initial complete PRP. One-third required retinal surgery, 16% needed intravitreal injection. Men (74.5%) had significant higher risk for vitreous (VR) surgery. Of the group with low-risk PDR, 56.8% did not require VR surgery, p < 0.001. Of the patients who underwent cataract surgery and had intravitreal anti-VEGF injections, 78.5 and 28.2% needed subsequent vitreous (VR) surgery, p = 0.006 and <0.0001, respectively. Independent predictors of need for vitreoretinal surgery included those who underwent cataract surgery and those with poor baseline visual acuity (logMAR). Eyes at lower risk for VR surgery included the eyes previously treated with PRP and low-risk PDR at baseline. CONCLUSION: Despite initial "complete" PRP, one-third of our study cohort needed vitrectomies over 10 years, highlighting that these patients require regular follow-up for a long period of time.