Long-Standing Macula-Involving Diabetic Tractional Retinal Detachments with Good Visual Acuity: How Should We Manage These Patients?

Abstract

Purpose

We assess the merits of pars plana vitrectomy (PPV) in subjects with good visual acuity (VA) and a chronic macula-involving tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR).

Methods

A retrospective review of medical records was undertaken. Subjects were divided into 1) a Study Group of subjects who underwent prompt PPV and 2) a Control Group of subjects in which PPV was deferred in favor of less invasive treatment options or observations. Both study and control subjects had a baseline Snellen VA of ≥20/50 and a PDR-associated macula-involving TRD of >6 months duration with a minimum follow-up of 12-months.

Results

There were 58 patients analyzed over an average follow-up period of 27.6 (±7.1) months. The change in VA was similar in the Study Group compared to the Control Group (p=0.94) with both groups losing about three lines of VA during the study period (−0.30 ±0.52 logMAR). Although the rates of maintaining ≥20/200 Snellen VA and ≥20/50 Snellen VA were similar in the Study Group compared to the Control Group (p=0.55 and p=0.28, respectively), the Study Group had more subjects gaining ≥2 lines of VA during the study period (p=0.002).

Conclusion

Patients presenting with good VA and a PDR-associated macula-involving TRD of >6 months were more likely to gain ≥2 lines of VA when PPV was performed at baseline compared to PPV deferral until further deterioration occurred.

Keywords:

• chronic tractional retinal detachment
• diabetic vitrectomy
• good visual acuity

Abbreviations

OCT, optical coherence tomography; TRD, tractional retinal detachment; PDR, proliferative diabetic retinopathy; PPV, pars plana vitrectomy; VA, visual acuity; VEGF, vascular endothelial growth factor.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics

The study was approved by the Panhandle Eye Group Institutional Review Board (IORG0009239; IRB00011013-17) in accordance with the Ethical Standards laid down in the Declaration of Helsinki.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval for the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

None are relevant to this study; the authors have no financial, proprietary, or other competing interests to disclose.

Additional information

Funding

There is no funding to report.