Outcomes of Pars Plana Vitrectomy with Panretinal Photocoagulation for Treatment of Proliferative Diabetic Retinopathy Without Retinal Detachment: A Seven-Year Retrospective Study

Abstract

Objective

To review clinical outcomes of patients with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) who underwent pars plana vitrectomy (PPV) with endolaser panretinal photocoagulation (PRP) without retinal detachment (RD) repair.

Methods

Retrospective chart review of the rate of postoperative clinical findings and visual acuity in patients with PDR from May 2014 to August 2021.

Results

Pars plana vitrectomy with endolaser PRP was performed in 81 eyes of 81 patients (mean age of 62.1 ± 10.5 years). At a median follow-up of 18 months, mean Snellen best-corrected visual acuity (BCVA) significantly improved from 20/774 preoperatively to 20/53 at last follow-up (P < 0.001). Postoperative complications and clinical findings included VH (12.3%), diabetic macular edema (DME) (12.3%), ocular hypertension (8.6%), RD (4.9%), and need for additional PPV (6.2%). Eyes with PRP performed within 6 months before surgery had a lower frequency of developing postoperative VH (5.3%) compared to eyes that received PRP more than 6 months before surgery (27.3%, P = 0.04). Eyes that received preoperative anti-vascular endothelial growth factor (VEGF) treatment (2.0%) had a lower frequency of postoperative VH compared to eyes that did not receive anti-VEGF treatment (14.3%, P = 0.04). Eyes that received intraoperative sub-tenon triamcinolone acetonide developed postoperative DME (4.0%) less frequently than eyes that did not receive sub-tenon triamcinolone acetonide (26.7%, P = 0.04).

Conclusion

In patients with PDR and VH, PPV with PRP yielded significant improvements in visual acuity and resulted in overall low rates of recurrent postoperative VH. Preoperative anti-VEGF and PRP laser treatment were associated with lower rates of postoperative VH. Furthermore, intraoperative use of sub-tenon triamcinolone acetonide was associated with a lower rate of postoperative DME. Pars plana vitrectomy with endolaser PRP in conjunction with the aforementioned pre- and intraoperative therapies is an effective treatment for patients with PDR and VH.

Keywords:

• pars plana vitrectomy
• panretinal photocoagulation
• vitreous hemorrhage
• vascular endothelial growth factor
• sub-tenon triamcinolone acetonide

Abbreviations

BCVA, Best corrected visual acuity; CPT, current procedural terminology DME, diabetic macular edema; HbA1c, hemoglobin A1c; ILM, internal limiting membrane; logMAR, Logarithm of the Minimum Angle of Resolution, NVD, neovascularization of the disc; NVE, neovascularization elsewhere; OCT, optical coherence tomography; PRP, panretinal photocoagulation; PPV, pars plana vitrectomy; PDR, proliferative diabetic retinopathy; RD, retinal detachment; VEGF, vascular endothelial growth factor; VH, vitreous hemorrhage.

Acknowledgments

This paper was presented at the Association for Research in Vision and Ophthalmology as an abstract presentation with interim and preliminary findings. The poster’s abstract was published in “Poster Abstracts” in Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2212: https://iovs.arvojournals.org/article.aspx?articleid=2780520.

Disclosure

Dr. Yannuzzi is a consultant for Genentech, Alcon, and REGENXBIO. Dr. Sridhar is a consultant for Alcon, Allergan, Apellis, Dorc, Genentech, Ocuterra, and Regeneron. The authors report no other conflicts of interest in this work.

Additional information

Funding

Bascom Palmer Eye Institute received funding from the NIH Core Grant P30EY014801, Department of Defense Grant #W81XWH-13-1-0048, and a Research to Prevent Blindness Unrestricted Grant. The sponsors or funding organizations had no role in the design or conduct of this research.