Vitrectomy Results in Proliferative Diabetic Retinopathy

Vitrectomy results in proliferative diabetic retinopathy
Clinical Research

Foundation items: Takeda Science Foundation of Japan and Asia
Ophthalmologist Training Foundation of Japan
1
Department of Ophthalmology, Zhongda Hospital of the Southeast
University, Nanjing 210009, Jiangsu Province, China

2
Eye Care Nagoya, Nagoya 450-0002, Japan
Department of Ophthalmology, National Nagoya Hospital, Nagoya
460-0001, Japan
Correspondence to: Jie Luan. Department of Ophthalmology,
Zhongda Hospital of the Southeast University, Nanjing 210009,
Jiangsu Province, China. [email protected]
Received: 2008-03-08
Accepted: 2008-08-16
Abstract
AIM: To evaluate the effectiveness of vitrectomy on eyes

with proliferative diabetic retinopathy (PDR).
METHODS:
A total of 139 eyes of 93 cases with PDR
underwent vitrectomy and were followed up for 3-24 months

(16.72 8.53 months; mean SD). The visual acuity and the
factors causing recurrence of operation were analyzed.
RESULTS:
The visual acuity was improved in 98 eyes
(70.50% ) after vitrectomy. The mean postoperative visual

acuity was significantly better than the mean preoperative
visual acuity. The main reasons for the failure of operation
were retinal detachment and maculopathy.
CONCLUSION: These results demonstrate that vitrectomy is

generally an effective procedure in treating PDR.
KEYWORDS: proliferative diabetic retinopathy; vitrectomy;

retrospective study
Luan J, Ando F, Hirose H, Yasui O. Vitrectomy results in proliferative
diabetic retinopathy.
2008;1(4):356-358
INTRODUCTION
roliferative diabetic retinopathy (PDR) is the serious

complication of diabetes mellitus. PDR is the main
cause for blindness in western countries. In this study, we

retrospectively reviewed the patient charts of 139 eyes that
underwent vitrectomy in National Nagoya Hospital. The surgical results, surgical complications, and visual acuity were
tabulated and summarized.
356
MATERIALS AND METHODS

This was a retrospective study of the effect of vitrectomy on
139 eyes of 93 cases with PDR. Pars plana vitrectomy was
performed at National Nagoya Hospital between January
2000 and February 2001. The clinical characteristics of the
93 patients were listed in Table 1. The patients included 57
men and 36 women whose age ranged from 23 to 84 years
(58.37 11.56 years; mean SD). Sixteen eyes of 10 patients
were type I diabetes mellitus and 83 patients (123 eyes)
were type II diabetes mellitus. The duration of diabetes was
for 2 to 35 years (14.34 8.15 years; mean SD). All eyes
had received 1 or 2 times retina photocoagulation before the
development of PDR. The preoperative visual acuity was
from light perception to 0.5. Cataract extraction with
implantation of an intraocular lens had performed previously
in 27 eyes. One eye was aphakic eye. Preoperative fundus
fluorescein angiography (FFA) was performed in 125 eyes
of 82 patients. Macular edema was diagnosed by FFA and
optical coherence tomography (OCT).
Among 139 eyes of 93 cases, vitreous hemorrhage (VH)
without retinal detachment (RD) were 24 eyes of 19 cases,
VH with RD were 14 eyes of 11 cases, preoperative
membrane in vitreous without RD were 18 eyes of 13 cases,
epiretinal membrane were 21 eyes of 17 cases, tractional
retinal detachment (TRD) were 38 eyes of 29 cases, macular
edema were 48 eyes of 31 cases, macular hole were 5 eyes
of 4 cases, branch retinal vein occlusion (BRVO) were 2
eyes of 2 cases, neovascularization of optic disc (NVO)
were 6 eyes of 5 cases.
For follow-up, all patients were seen at regularly intervals
after operation. The duration of follow-up was for 3-24
months (16.728.53 months; meanSD).
The surgical procedure was a standard three-port pars plana
vitrectomy. Posterior vitreous was detached from the optic
disc by using high suction power with the vitrectomy
instrument at optic disc until detachment was created. The
other procedures during operation included proliferative
membrane removal, epiretinal membrane peeling, ICG
assisted ILM peeling, retina holes or tears treatments by
using photocoagulation or cryocoagulation, air-fluid exchange.
At the end of the operations, 120-140mL/L C3F8 or 150200mL/L SF6 or silicone oil were injected.
1 4 Dec188 www. IJO. cn

8629 8629-83085628
Along with the vitrectomy, 6 eyes of 6 cases were

performed phacoemulsification and IOL implantation, 3 eyes
of 2 cases were performed nuclear phacofragmentation. IOL
were removed from 2 eyes of 1 case. Gas tamponade were
126 eyes of 80 cases, silicone oil tamponade were 8 eyes of
8 cases.
Statistical Analysis Snellen visual acuities were converted
to a logarithmic scale (LogMAR), as described earlier [1].
This conversion is very good, however, usually Japan use
decimal visual acuity chart, not the Snellen chart. Comparisons between preoperative and postoperative visual acuities
were performed using Wilcoxon signed rank test. The visual
acuity was the best corrected visual acuity.
RESULTS
Among 139 eyes of 93 cases, 108 eyes of 66 cases received
one time vitrectomy, and 31 eyes of 27 cases received multiply
operations from 2-6 times. The mean time of operations was
1.37 times.
The factors which caused reoperation were retinal detachment
(22 eyes of 21 cases), macular edema (6 eyes of 5 cases),
vitreous hemorrhage (1 eye of 1 case), secondary glaucoma
(6 eyes of 5 cases).
Ninety-eight eyes (70.50%) had an increase in visual acuity
after vitrectomy. Fourteen eyes (10.07%) visual acuity were
equal to preoperative acuity. Twenty-seven eyes (19.43%)
postoperative visual acuity were decreased. The preoperative
and postoperative mean visual acuity were 0.1521 0.1674
(light perception to 0.5) and 0.39030.3364(light perception to
1.2) respectively. The postoperative mean visual acuity was
significantly better than the preoperative mean visual acuity,
Table 2 (Wilcoxon signed-ranked test, =6.9710,
and Table 3.
<0.001)
Table 1
patients
Variable
complications of diabetic mellitus which could cause

blindness. This retrospective study of the outcome of
vitrectomy in 139 eyes of proliferative diabetic retinopathy
showed positive results; the visual acuity was improved in
70.50% eyes after surgery and was significantly better than
preoperation. Our vitrectomy results on proliferative diabetic
retinopathy confirmed the earlier studies by Luan [2].
Vitrectomy could remove vitreous hemorrhage, peel epiretinal
membranes as well as proliferative fibroneovascular
membranes, remove growth factors which may be related to
diabetic retinopathy, and re-attach the detached retina.
Vitrectomy is an effective method to treat proliferative
diabetic retinopathy.
Median (range)/(%)
Age a
Follow-up a
58.3711.56(23-84)yr
16.728.53(3-24)mo
Duration of Diabetes a
Visual acuitya
Sex
14.348.15(2-35)yr
0.15210.1674 (LP-0.5)
Male
Female
57 (61.29)
36 (38.71)
Type of Diabetes Mellitus b

Insulin-dependent
Non-insulin-dependent
Status of PDR b
10 (10.75)
83 (89.25)
VH
VH+RD
24 (17.27)
14 (10.07)
Proliferative membrane without

RD
18 (12.95)
Epiretina membrane
TRD
21 (15.11)
38 (27.34)
Macular edema
BRVO
48 (34.53)
2 (1.44)
NVO
Lens status b
6 (4.32)
Pseudphakic
Aphakic
27 (19.42)
1 (0.72)
Clear lens
102 (73.38)
9 (6.47)
Cataract
a
median(range),b (%)
Table 2
Visual acuity change after vitrectomy
Change
Number of eyes(%)
Improvement
41(29.50)
6 lines
3 lines, <6 lines
33(23.74)
1 line, <3 lines
24(17.27)
No change
14(10.07)
Deterioration
DISCUSSION
Proliferative diabetic retinopathy is one of the serious
Baseline clinical characteristic of 139 eyes of 93
Table 3
10(7.19)
1line
>1 line, 3lines
8(5.76)
>3lines
9(6.47)
Preoperative and Postoperative Visual Acuity
(VA)
a
Preoperative VA
Postoperative VA
0.1521 0.1674
0.3903 0.3364
<0.001
Wilcoxon signed-ranked test,t=6.9710,P<0.001
Though vitrectomy could reduce the traction exerted on

retina by vitreous membranes and remove some related
growth factors, and increase the preretinal oxygen tension to
cause retinal vasoconstriction and reduce vascular leakage
and diabetic macular edema [3]. In this study, 11 eyes had no
visual acuity improvement or worse visual acuity with
maculopathy. This result suggests that the process of
357
diabetic macular edema is complicated and the pathogenesis

of diabetic macular edema may be caused by multifactors. A
shorter interval from initial diagnosis of macular edema to
vitrectomy may be associated with a better visual acuity
outcome [4]. Another reason which caused poor visual acuity
and the failure of surgery was retinal detachment. These
cases had thickened retina or shortened retina in serious
proliferative diabetic retinopathy, retinotomy combined with
endophotocoagulation and intravitreous tamponade are often
needed to reattach the retina. But there were still some
failure cases because of retinal re-detachment. We suggest
that we should treat complications early if happened after
surgery. In this study, there was a typical case who received
6 operations of vitrectomy,lenscotomy,retinotomy, intravitreous gas-tamponade, intravitreous silicone oil tamponade
and, at last, whose visual acuity was improved from 0.01 to 0.2.
358
From this retrospective study, we conclude that vitrectomy is

an effective procedure to treat proliferative diabetic
retinopathy and earlier vitrectomy may obtain good visual
acuity result and avoid serious complications such as macular edema and retinal detachment.
REFERENCES
1 Ferris FL III, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for
clinical research.
1982;94(1):91-96
2 Luan J, Li CS, Sun JN, Ni Y. Vitrectomy combined with endolaser to treat proliferative diabetic retinopathy.
2002;22(3):202-203
3 Stefansson E, Novack RL, Hatchel DL . Vitrectomy prevents retinal hypoxia in branch retinal vein occlusion.
1990;31 (2) :
284-289
4 Harbour JW, Smiddy WE, Flynn HW, Rubsamen PE. Vitrectomy for diabetic
macular edema associated with a thickened and taut posterior hyaloid membrane.
1996;121(4):405-413

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Vitrectomy results in proliferative diabetic retinopathy

Vitrectomy results in proliferative diabetic retinopathy

Department of Ophthalmology, Zhongda Hospital of the Southeast

University, Nanjing 210009, Jiangsu Province, China

Eye Care Nagoya, Nagoya 450-0002, Japan

Department of Ophthalmology, National Nagoya Hospital, Nagoya

AIM: To evaluate the effectiveness of vitrectomy on eyes

A total of 139 eyes of 93 cases with PDR

underwent vitrectomy and were followed up for 3-24 months

The visual acuity was improved in 98 eyes

(70.50% ) after vitrectomy. The mean postoperative visual

CONCLUSION: These results demonstrate that vitrectomy is

KEYWORDS: proliferative diabetic retinopathy; vitrectomy;

roliferative diabetic retinopathy (PDR) is the serious

cause for blindness in western countries. In this study, we

MATERIALS AND METHODS

1 4 Dec188 www. IJO. cn

Along with the vitrectomy, 6 eyes of 6 cases were

complications of diabetic mellitus which could cause

Type of Diabetes Mellitus b

Proliferative membrane without

Visual acuity change after vitrectomy

1 line, <3 lines

Baseline clinical characteristic of 139 eyes of 93

Preoperative and Postoperative Visual Acuity

Wilcoxon signed-ranked test,t=6.9710,P<0.001

Though vitrectomy could reduce the traction exerted on

Vitrectomy results in proliferative diabetic retinopathy

diabetic macular edema is complicated and the pathogenesis

From this retrospective study, we conclude that vitrectomy is

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