Skip to main content

Advertisement

SpringerLink
Log in

Clinical variables and their relation to visual outcome after vitrectomy in eyes with diabetic retinal traction detachment

  • Clinical Investigation
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To analyse vitrectomy results in diabetic eyes with retinal traction detachment and to investigate which variables are associated with a worse visual outcome.

Methods

Forty-four diabetic eyes (33 patients) with central retinal traction detachment were analyzed retrospectively.

Results

After a median follow-up of 10 months, median visual acuity significantly improved from 20/800 to 20/160 (P=0.02), despite the fact that the majority of patients had a long-standing macular traction detachment (median 120 days). Twenty-two eyes (50%) achieved a visual acuity of >20/200. The retina was finally reattached in 38 eyes (86.3%). Univariate analysis showed that patients with type 2 diabetes, age older than 50 years, preoperative visual acuity <20/200, iris neovascularisation and macular detachment of >30 days had a significantly worse final visual outcome. After multiple logistic regression analysis, age and iris neovascularisation were the strongest predictors of a worse visual outcome; if both were present, the chance of a obtaining a visual outcome of <20/200 was almost 90%.

Conclusions

Age and iris neovascularisation were the strongest predictors for a low visual outcome. In a review of vitrectomy studies in eyes with severe diabetic traction detachment in the past 2 decades, we found a trend towards higher anatomic success rates, while visual outcome only slightly improved. The current study confirmed the importance of ophthalmic variables, but also indicates the importance of evaluating systemic variables in larger series in order to predict which eyes may truly benefit from vitrectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Aaberg TM (1981) Pars plana vitrectomy for diabetic traction retinal detachment. Ophthalmology 88:639–642

    CAS  PubMed  Google Scholar 

  2. Abrams GW, Williams GA (1987) “En bloc” excision of diabetic membranes. Am J Ophthalmol 103:302–308

    CAS  PubMed  Google Scholar 

  3. Ah-Fat FG, Sharma MC, Majid MA, et al (1999) Trends in vitreoretinal surgery at a tertiary referral centre: 1987 to 1996. Br J Ophthalmol 83:396–398

    CAS  PubMed  Google Scholar 

  4. Aiello LP, Cahill MT, Wong JS (2001) Sytemic considerations in the management of diabetic retinopathy. Am J Ophthalmol 132:760–776

    Google Scholar 

  5. Azen SP, Scott IU, Flynn HW Jr, et al (1998) Silicone oil in the repair of complex retinal detachments. A prospective observational multicenter study. Ophthalmology 105:1587–1597

    Article  CAS  PubMed  Google Scholar 

  6. Brourman ND, Blumenkranz MS, Cox MS, et al (1989) Silicone oil for the treatment of severe proliferative diabetic retinopathy. Ophthalmology 96:759–764

    Google Scholar 

  7. Bustros de S, Thompson JT, Michels RG, Rice TA (1987) Vitrectomy for progressive proliferative diabetic retinopathy. Arch Ophthalmol 105:196–199

    PubMed  Google Scholar 

  8. Castellarin A, Grigorian R, Bhagat N, Del Priore L, Zarbin MA (2003) Vitrectomy with silicone oil infusion in severe diabetic retinopathy. Br J Ophthalmol 87:318–321

    Article  CAS  PubMed  Google Scholar 

  9. Charles S (1981) Vitreous Microsurgery. Williams and Wilkins, Baltimore, pp 107–120

  10. 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

    PubMed  Google Scholar 

  11. Ferris FL, Kassoff A, Bresnick GH, et al (1982) New visual acuity charts for clinical research. Am J Ophthalmol 94:91–96

    PubMed  Google Scholar 

  12. Han DP, Murphy ML, Mieler WF (1994) A modified en bloc excision technique during vitrectomy for diabetic traction retinal detachment. Ophthalmology 101:803–808

    CAS  PubMed  Google Scholar 

  13. Harrel F, Lee K, Mark D (1996) Tutorial in biostatistics multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387

    PubMed  Google Scholar 

  14. Helbig H, Kellner U, Bornfeld N, et al (1996) Life expectancy of diabetic patients undergoing vitreous surgery. Br J Ophthalmol 80:640–643

    CAS  PubMed  Google Scholar 

  15. Imamura Y, Minami M, Ueki M, et al (2003) Use of perfluorocarbon liquid during vitrectomy for severe proliferative diabetic retinopathy. Br J Ophthalmol 87:563–566

    Article  CAS  PubMed  Google Scholar 

  16. Kakehashi A (2002). Total en bloc excision: a modified vitrectomy technique for proliferative diabetic retinopathy. Am J Ophthalmol 134:763–765

    Article  PubMed  Google Scholar 

  17. Kroll P, Wiegand W, Schmidt J (1999) Vitreopapillary traction in proliferative diabetic vitreoretinopathy; Br J Ophthalmol 83:261–264

    Google Scholar 

  18. La Heij EC, Hendrikse F, Kessels AGH et al (2001) Vitrectomy results in diabetic macular oedema without evident vitreomacular traction. Graefes Arch Clin Exp Ophthalmol 239:264–270

    PubMed  Google Scholar 

  19. Lucke KH, Foerster MH, Laqua H (1987) Long-term results of vitrectomy and silicone oil in 500 cases of complicated retinal detachments. Am J Ophthalmol 104:624–633

    CAS  PubMed  Google Scholar 

  20. Maturi RK, Merrill PT, Lomeo MD, Diaz-Rohena R, Khan M, Lambert HM (1999) Perfluoro-N-octane (PFO) in the repair of complicated retinal detachments due to severe proliferative diabetic retinopathy. Ophthalmic Surg Lasers 30:715–720

    CAS  PubMed  Google Scholar 

  21. McCuen BW 2nd, Rinkoff JS (1989) Silicone oil for progressive anterior ocular neovascularisation after failed diabetic vitrectomy. Arch Ophthalmol 107:677–682

    PubMed  Google Scholar 

  22. Meier P, Wiedemann P (1997) Vitrectomy for traction macular detachment in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 235:569–574

    CAS  PubMed  Google Scholar 

  23. Meredith TA, Kaplan HJ, Aaberg TM (1980) Pars plana vitrectomy techniques for relief of epiretinal traction by membrane segmentation. Am J Ophthalmol 89:408–413

    CAS  PubMed  Google Scholar 

  24. Rice TA, Michels RG (1983) Vitrectomy for diabetic rhegmatogenous retinal detachment. Am J Ophthalmol 95:34–44

    Google Scholar 

  25. Rice TA, Michels RG, Rice EF (1983) Vitrectomy for diabetic retinal detachment involving the macula. Am J Ophthalmol 95:22–33

    CAS  PubMed  Google Scholar 

  26. Rinkoff JS, de Juan E Jr, McCuen BW 2nd (1986) Silicone oil for retinal detachment with advanced proliferative vitreoretinopathy following failed vitrectomy for proliferative diabetic retinopathy. Am J Ophthalmol 101:181–186

    CAS  PubMed  Google Scholar 

  27. Scott IU, Flynn HW, Lai M, et al (2000) First operation anatomic success and other predictors of postoperative vision after complex retinal detachment repair with vitrectomy and silicone oil tamponade. Am J Ophthalmol 130:745–750

    Article  CAS  PubMed  Google Scholar 

  28. Steinmetz RL, Grizzard S, Hammer ME (2002) Vitrectomy for diabetic tration retinal detachment using the multiport illumination system. Ophthalmology 109:2303–2307

    Article  PubMed  Google Scholar 

  29. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2000) Retinopathy and nephropathy in patients with type 1 diabetes 4 years after a trial of intensive therapy. N Engl J Med 342:381–389

    Article  PubMed  Google Scholar 

  30. Thompson JT, Bustros de S, Michels RG, Rice TA (1987) Results and prognostic factors in vitrectomy for diabetic traction retinal detachment of the macula. Arch Ophthalmol 105:497–502

    CAS  PubMed  Google Scholar 

  31. Thompson JT, Bustros de S, Michels RG, Rice TA (1987) Results and prognostic factors in vitrectomy for diabetic traction retinal detachment of the macula. Arch Ophthalmol 105:503–507

    CAS  PubMed  Google Scholar 

  32. UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. BMJ 31:317:703–713

    Google Scholar 

  33. Williams DF, George A. Williams, Arthur Hartz, William F. Mieler, Gary W. Abrams, Aaberg TM (1989) Results of vitrectomy for diabetic traction retinal detachments using the en bloc excision technique. Ophthalmology 96:752–758

    Google Scholar 

  34. Yeo JH, Glaser BM, Michels RG (1987) Silicone oil in the treatment of complicated retinal detachments. Ophthalmology 94:1109–1113

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

    Ellen C. La Heij, Sadettin Tecim, Albert T. A. Liem, Wouter J. Japing & Fred Hendrikse

  2. Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, Maastricht, The Netherlands

    Alfons G. H. Kessels

Authors
  1. Ellen C. La Heij
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sadettin Tecim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alfons G. H. Kessels
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Albert T. A. Liem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wouter J. Japing
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fred Hendrikse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ellen C. La Heij.

Additional information

The authors have not received any financial support. The authors have no proprietary interest related to this article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

La Heij, E.C., Tecim, S., Kessels, A.G.H. et al. Clinical variables and their relation to visual outcome after vitrectomy in eyes with diabetic retinal traction detachment. Graefe's Arch Clin Exp Ophthalmol 242, 210–217 (2004). https://doi.org/10.1007/s00417-003-0815-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-003-0815-5

Keywords

Search

Navigation