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Vitrectomy for complications of proliferative diabetic retinopathy in young adults: clinical features and surgical outcomes

  • Retinal Disorders
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Abstract

Purpose

To investigate the clinical manifestations and surgical results after vitrectomy for proliferative diabetic retinopathy (PDR) in young patients.

Methods

Clinical features of patients between 18 to 40 years old who received vitrectomy for PDR between January 2009 and January 2015 were retrospectively reviewed. Those older than 40 years who received vitrectomy for PDR during the same period were retrospectively enrolled and compared as the control group.

Results

There were 68 eyes (52 patients) in the study group and 77 eyes (61 patients) in the control group. The average age at operation was 33.15 ± 4.92 years and 56.67 ± 7.52 years, respectively (p < 0.001). At presentation, those in the study group had significantly higher proportions of active fibrovascular proliferation and traction retinal detachment, and with significantly higher-severity gradings than those in the control group. After operation, the recurrent detachment rates were 13.2% in the study group and 1.3% in the control group (p = 0.006), and the final anatomical success rates were 91.2% in the study group and 100% in the control group (p = 0.009). The most significant risk factor for poor visual outcome in the study group was neovascular glaucoma (NVG) (p = 0.001). Patients with Type 1 and Type 2 diabetes mellitus subgroups shared similar clinical features and visual outcome.

Conclusions

Younger patients who received vitrectomy for PDR presented with more severe anatomical features at the time of vitrectomy and had a higher rate of post-operative recurrent detachment. More than 90% achieved final anatomical success. NVG was associated with worse visual outcome.

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References

  1. Yokoyama H, Okudaira M, Otani T, Takaike H, Miura J, Saeki A, Uchigata Y, Omori Y (1997) Existence of early-onset NIDDM Japanese demonstrating severe diabetic complications. Diabetes Care 20(5):844–847

    Article  CAS  PubMed  Google Scholar 

  2. Giusti C (2001) Retinopathy in juvenile diabetes: a 10-year (1990-2000) review. Pediatr Diabetes 2(2):83–93. doi:10.1034/j.1399-5448.2001.002002083.x

    Article  CAS  PubMed  Google Scholar 

  3. Ostri C, la Cour M, Lund-Andersen H (2014) Diabetic vitrectomy in a large type 1 diabetes patient population: long-term incidence and risk factors. Acta Ophthalmol 92(5):439–443. doi:10.1111/aos.12249

    Article  PubMed  Google Scholar 

  4. Wong J, Molyneaux L, Constantino M, Twigg SM, Yue DK (2008) Timing is everything: age of onset influences long-term retinopathy risk in type 2 diabetes, independent of traditional risk factors. Diabetes Care 31(10):1985–1990. doi:10.2337/dc08-0580

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY (2006) Epidemic obesity and type 2 diabetes in Asia. Lancet 368(9548):1681–1688. doi:10.1016/S0140-6736(06)69703-1

    Article  PubMed  Google Scholar 

  6. Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, Beckles GL, Saaddine J, Gregg EW, Williamson DF, Narayan KM (2000) Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 136(5):664–672

    Article  CAS  PubMed  Google Scholar 

  7. Song SH (2015) Complication characteristics between young-onset type 2 versus type 1 diabetes in a UK population. BMJ Open Diabetes Res Care 3(1):e000044. doi:10.1136/bmjdrc-2014-000044

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dart AB, Martens PJ, Rigatto C, Brownell MD, Dean HJ, Sellers EA (2014) Earlier onset of complications in youth with type 2 diabetes. Diabetes Care 37(2):436–443. doi:10.2337/dc13-0954

    Article  CAS  PubMed  Google Scholar 

  9. Rajalakshmi R, Amutha A, Ranjani H, Ali MK, Unnikrishnan R, Anjana RM, Narayan KM, Mohan V (2014) Prevalence and risk factors for diabetic retinopathy in Asian Indians with young onset type 1 and type 2 diabetes. J Diabetes Complications 28(3):291–297. doi:10.1016/j.jdiacomp.2013.12.008

    Article  PubMed  Google Scholar 

  10. Hsu YJ, Hsieh YT, Yeh PT, Huang JY, Yang CM (2014) Combined tractional and rhegmatogenous retinal detachment in proliferative diabetic retinopathy in the anti-VEGF Era. J Ophthalmol 2014:917375. doi:10.1155/2014/917375

    Article  PubMed  PubMed Central  Google Scholar 

  11. Holladay JT (1997) Proper method for calculating average visual acuity. J Refract Surg 13(4):388–391

    CAS  PubMed  Google Scholar 

  12. Singerman LJ, Weaver DT (1981) PDR in juvenile onset diabetics: high-risk proliferative diabetic retinopathy in juvenile onset diabetics. Retina 1(1):18–26

    CAS  PubMed  Google Scholar 

  13. Kingsley R, Ghosh G, Lawson P, Kohner EM (1983) Severe diabetic retinopathy in adolescents. Br J Ophthalmol 67(2):73–79

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. The Diabetic Retinopathy Vitrectomy Study Research Group (1985) Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. Arch Ophthalmol 103(11):1644–1652

    Article  Google Scholar 

  15. Lattanzio R, Brancato R, Bandello FM, Azzolini C, Malegori A, Maestranzi G (2001) Florid diabetic retinopathy (FDR): a long-term follow-up study. Graefes Arch Clin Exp Ophthalmol 239(3):182–187

    Article  CAS  PubMed  Google Scholar 

  16. Pinhas-Hamiel O, Zeitler P (2007) Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. Lancet 369(9575):1823–1831. doi:10.1016/S0140-6736(07)60821-6

    Article  PubMed  Google Scholar 

  17. Hillier TA, Pedula KL (2003) Complications in young adults with early-onset type 2 diabetes: losing the relative protection of youth. Diabetes Care 26(11):2999–3005

    Article  PubMed  Google Scholar 

  18. Raczynska D, Zorena K, Urban B, Zalewski D, Skorek A, Malukiewicz G, Sikorski BL (2014) Current trends in the monitoring and treatment of diabetic retinopathy in young adults. Mediators Inflamm 2014:492926. doi:10.1155/2014/492926

    Article  PubMed  PubMed Central  Google Scholar 

  19. Okudaira M, Yokoyama H, Otani T, Uchigata Y, Iwamoto Y (2000) Slightly elevated blood pressure as well as poor metabolic control are risk factors for the progression of retinopathy in early-onset Japanese Type 2 diabetes. J Diabetes Complications 14(5):281–287

    Article  CAS  PubMed  Google Scholar 

  20. Henricsson M, Nystrom L, Blohme G, Ostman J, Kullberg C, Svensson M, Scholin A, Arnqvist HJ, Bjork E, Bolinder J, Eriksson JW, Sundkvist G (2003) The incidence of retinopathy 10 years after diagnosis in young adult people with diabetes: results from the nationwide population-based Diabetes Incidence Study in Sweden (DISS). Diabetes Care 26(2):349–354

    Article  PubMed  Google Scholar 

  21. Kakehashi A, Trempe CL, Fujio N, McMeel JW, Schepens CL (1994) Retinal breaks in diabetic retinopathy: vitreoretinal relationships. Ophthalmic Surg 25(10):695–699

    CAS  PubMed  Google Scholar 

  22. Sayin N, Kara N, Pekel G (2015) Ocular complications of diabetes mellitus. World J Diabetes 6(1):92–108. doi:10.4239/wjd.v6.i1.92

    Article  PubMed  PubMed Central  Google Scholar 

  23. Osaadon P, Fagan XJ, Lifshitz T, Levy J (2014) A review of anti-VEGF agents for proliferative diabetic retinopathy. Eye (Lond) 28(5):510–520. doi:10.1038/eye.2014.13

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan

    Chu-Hsuan Huang, Yi-Ting Hsieh & Chung-May Yang

  2. Department of Ophthalmology, National Taiwan University College of Medicine, No. 7, Chun-Shan S. Rd., Taipei City, 100, Taiwan

    Yi-Ting Hsieh & Chung-May Yang

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  1. Chu-Hsuan Huang
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Correspondence to Chung-May Yang.

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No funding was received for this research.

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None of the authors has a proprietary interest.

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Huang, CH., Hsieh, YT. & Yang, CM. Vitrectomy for complications of proliferative diabetic retinopathy in young adults: clinical features and surgical outcomes. Graefes Arch Clin Exp Ophthalmol 255, 863–871 (2017). https://doi.org/10.1007/s00417-016-3579-4

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  • DOI: https://doi.org/10.1007/s00417-016-3579-4

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