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Increasing metabolic variability increases the risk for vitrectomy in proliferative diabetic retinopathy

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Abstract

Purpose

Proliferative diabetic retinopathy (PDR) can be treated by retinal photocoagulation, but in some cases, the treatment is initiated too late or is insufficient so that the disease advances to a stage requiring vitrectomy. There is a need to identify risk factors that can predict if patients with PDR will develop complications in need for vitrectomy.

Methods

Survival analysis with death as competing risk was used to study systemic risk factors for PDR progression to a complication in need for vitrectomy in right eyes of all 1288 diabetic patients from the Aarhus area, Denmark, who had developed proliferative retinopathy in the right eye during the 25 years period from 1 July 1994 until 1 July 2019.

Results

The overall cumulative incidence of reaching a vitrectomy end point in the right eye was 24.1% (n = 311). In 9.3% (n = 120) of the patients where vitrectomy had been performed together with the first photocoagulation, the age of onset of diabetes was significantly higher (p < 0.0001), the diabetes duration longer (p < 0.035) and BMI higher (p < 0.01) than in the patients who had been vitrectomized later than the first photocoagulation. The risk for vitrectomy was significantly increased by high variability of HbA1c before the development of PDR (p < 0.0001), but not by other parameters known to increase the risk for developing PDR.

Conclusion

Increasing variability of HbA1c before the development of PDR increases the risk for progression to a complication in need of vitrectomy. The need for vitrectomy is unaffected by other risk factors known to increase the risk for developing PDR.

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References

  1. Fong DS, Aiello L, Gardner TW et al (2004) Retinopathy in diabetes. Diabetes Care 10:2540–2553

    Article  Google Scholar 

  2. Wong TY, Sun J, Kawasaki R et al (2018) Guidelines on diabetic eye care: the international council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology 125(10):1608–1622

    Article  Google Scholar 

  3. The diabetic retinopathy vitrectomy study research group (1988) Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial–diabetic retinopathy vitrectomy study report 3. Ophthalmology 95:1307–1320

    Article  Google Scholar 

  4. The diabetic retinopathy vitrectomy study research group (1988) Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial–diabetic retinopathy vitrectomy study report 4. Ophthalmology 95:1321–1334

    Article  Google Scholar 

  5. Ostri C, la Cour M, Lund-Andersen H (2014) Diabetic vitrectomy in a large type 1 diabetes population: long-term incidence and risk factors. Acta Ophthalmol 92(5):439–443

    Article  Google Scholar 

  6. Parikh R, Shah RJ, VanHouten JP et al (2014) Ocular findings at initial panretinal photocoagulation for proliferative diabetic retinopathy predict the need for future pars plana vitrectomy. Retina 34(10):1977–2000

    Article  Google Scholar 

  7. Khan R, Surya J, Rajalakshmi R et al (2020) Need for vitreous surgeries in proliferative diabetic retinopathy in 10 years follow-up: India retinal disease study (IRDS) group report no2. Ophthalmic Res 64(3):432–439. https://doi.org/10.1159/000512767

    Article  PubMed  Google Scholar 

  8. Bek T (2020) Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema. Diabetologia 63(11):2462–2470

    Article  CAS  Google Scholar 

  9. Bek T, Erlandsen M (2006) Visual prognosis after panretinal photocoagulation for proliferative diabetic retinopathy. Acta Ophthalmol 84(1):16–20

    Article  Google Scholar 

  10. Bek T, Møller F, Klausen B (2000) Short term visual prognosis after retinal laser photocoagulation for diabetic maculpathy. Acta Ophthalmol 78(5):539–542

    Article  CAS  Google Scholar 

  11. Jackson TL, Nicod E, Angelis A et al (2017) Pars plana vitrectomy for diabetic macular edema: a systematic review, meta-analysis, and synthesis of safety literature. Retina 37(5):886–895

    Article  Google Scholar 

  12. Holladay JT (2004) Visual acuity measurements. J Cat Refract Surg 30:287–290

    Article  Google Scholar 

  13. Silva PS, Diala PA, Haman R et al (2014) Visual outcomes from pars plana vitrectomy versus combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in patients with diabetes. Retina 34(10):1960–1968

    Article  Google Scholar 

  14. Wu L, Berrocal MH, Rodriquez FJ et al (2014) Intraocular pressure elevation after uncomplicated pars plana vitrectomy: results of the pan americal collaborative retina study group. Retina 34(10):1985–1989

    Article  Google Scholar 

  15. Bek T, Stefánsson E, Hardarson SH (2019) Retinal oxygen saturation is an independent risk factor for the severity of diabetic retinopathy. Br J Ophthalmol 103(8):1167–1172

    Article  Google Scholar 

  16. Song YS, Nagaoka T, Omae T et al (2016) Systemic risk factors in bilateral proliferative diabetic retinopathy requiring vitrectomy. Retina 36(7):1309–1313

    Article  CAS  Google Scholar 

  17. Ometto G, Assheton P, Calivas F et al (2017) Spatial distribution of early red lesions is a risk factor for development of vision-threatening diabetic retinopathy. Diabetologia 60:2361–2367

    Article  Google Scholar 

  18. Yorston D, Wickham L, Benson S et al (2008) Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol 92(3):365–368

    Article  CAS  Google Scholar 

  19. Huang CT, Hsieh YT, Yang CM (2017) Vitrectomy for complications of proliferative diabetic retinopathy in young adults: clinical features and surgical outcomes. Graefes Arch Clinc Exp Ophthalmol 255(5):863–871

    Article  Google Scholar 

  20. Hove M, Kristensen JK, Lauritzen T et al (2004) The prevalence of retinopathy in an unselected population of type 2 diabetes patients from Aarhus County Denmark. Acta Ophthalmol 82(4):443–448

    Article  Google Scholar 

  21. Voigt M, Schmidt S, Legmann T et al (2018) Prevalence and progression rate of diabetic retinopathy in type 2 diabetes patients in correlation with the duration of diabetes. Exp Clin Endocrinol Diabetes 126(9):570–576

    Article  CAS  Google Scholar 

  22. Slieker RC, van der Heijden AAWH, Nijpels G et al (2019) Visit-to-visit variability of glycemia and vascular complications: the hoorn diabetes care system cohort. Cardiovasc Diabetol 18(1):170. https://doi.org/10.1186/s12933-019-0975-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Bek T (2020) Incidence and risk for developing proliferative diabetic retinopathy after photocoagulation for diabetic maculopathy. Curr Eye Res 45(8):986–991

    Article  Google Scholar 

  24. Jørgensen CM, Bek T (2016) The systemic blood pressure and oxygen saturation in retinal arterioles predict the effect of intravitreal anti-VEGF treatment on diabetic maculopathy. Invest Ophthalmol Vis Sci 57:5429–5434

    Article  Google Scholar 

  25. Mehlsen J, Erlandsen M, Poulsen PL et al (2011) Identification of independent risk factors for the development of diabetic retinopathy requiring treatment. Acta Ophthalmol 89(6):515–521

    Article  Google Scholar 

  26. Sivaprasad S, Pearce E (2019) The unmet need for better risk stratification of non-proliferative diabetic retinopathy. Diabet Med 36(4):424–433

    CAS  PubMed  Google Scholar 

  27. Cruickshanks KJ, Moss SE, Klein R et al (1995) Physical activity and the risk of progression of retinopathy or the development of proliferative diabetic retinopathy. Ophthalmology 102(8):1177–1182

    Article  CAS  Google Scholar 

  28. Praidou A, Harris M, Niakas D et al (2017) Physical activity and its correlations to diabetic retinopathy. Diabetes Complicat 31(2):456–461

    Article  Google Scholar 

  29. Hainsworth DP, Bebu I, Aiello LP et al (2019) Risk factors for retinopathy in type 1 diabetes: the DCCT/EDIC study. Diabetes Care 42(5):875–882

    Article  CAS  Google Scholar 

  30. Aiello LP, Cahill MT, Wong JS (2001) Systemic considerations in the management of diabetic retinopathy. Am J Ophthalmol 132(5):760–766

    Article  CAS  Google Scholar 

  31. Noor AKCM, Tai ELM, Kueh YC et al (2020) Survival time of visual gains after diabetic vitrectomy and its relationship with ischemic heart disease. Int J Environ Res Public Health 17(1):310

    Article  Google Scholar 

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Acknowledgements

The skillful assistance of nurse photographers Helle Hedegaard and Tina Bjerre is gratefully acknowledged.

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The material is not available because this would imply the delivery of material that might identify individual patients.

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Authors and Affiliations

  1. Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark

    Toke Bek, Mette Slot Nielsen, Sidsel Ehlers Klug & Jesper Engholt Eriksen

Authors
  1. Toke Bek
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  2. Mette Slot Nielsen
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  3. Sidsel Ehlers Klug
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  4. Jesper Engholt Eriksen
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Contributions

Toke Bek conceived the study, performed the statistical analyses and wrote the draft manuscript. All authors contributed to the data collection, interpretation of results and commented on previous versions of the manuscript.

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Correspondence to Toke Bek.

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Conflict of interest

The authors have no relevant financial or non-financial interest to disclose.

Institutional board approvals

At request, the medical ethics committee stated that the reporting of anonymized data in the present study does not require consent from patients or ethical approval.

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Bek, T., Nielsen, M.S., Klug, S.E. et al. Increasing metabolic variability increases the risk for vitrectomy in proliferative diabetic retinopathy. Int Ophthalmol 42, 757–763 (2022). https://doi.org/10.1007/s10792-021-02041-3

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  • DOI: https://doi.org/10.1007/s10792-021-02041-3

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