This study population's visual acuity improved six months after PPV.
This study population's visual acuity improved six months after PPV. Photo: Derek N. Cunningham, OD. Click image to enlarge.

Patients with proliferative diabetic retinopathy–related complications have had better outcomes since the use of small-gauge pars plana vitrectomy (PPV) and anti-VEGF pretreatment began in the 2000s, according to a recently published study on updated clinical outcomes in these patients.

The researchers conducted a pooled analysis of five randomized clinical trials run through a single center, with PPV performed by the same surgeons. A total of 943 subjects received anti-VEGF pretreatment, which has been reported to reduce intraoperative and postoperative hemorrhaging as well as make membrane dissection during PPV easier, and small-gauge PPV, which has been reported to reduce surgical times, complications and result in better visual outcomes than 20-gauge PPV, regardless of anti-VEGF pretreatment.

At six months, the study population’s visual acuity improved, with 19.5% of patients achieving 20/50 or better and 69% of patients achieving 20/200 or better. In 95.5% of patients, vision improved or remained stable. Only 1.2% developed no light perception at six months.

Intraoperative complications occurred in 36.4% of cases, and 21% of cases experienced a postoperative complication, the most common of which was vitreous hemorrhage (62.3% of all complications); 9% of cases required unplanned secondary PPV.

The researchers’ subgroup analysis suggested the severity of the vitreoretinal adhesion grade may have impacted patient outcomes. “Patients with vitreous hemorrhage alone or with minimal traction have significantly better vision, shorter surgery times and fewer intraoperative and postoperative complications compared with patients with a tractional retinal detachment or extensive fibrovascular proliferation (grades 2-3 vitreoretinal adhesion),” the researchers wrote in their paper.

“The pooled analysis of this study can act as an updated benchmark for estimating the incidence of intraoperative and postoperative complications, as well as vision expectations in this patient population following PPV,” they concluded.

Rush RB, Rush SW, Reinauer RM, et al. Vitrectomy for diabetic complications: a pooled analysis of randomized controlled trials utilizing modern techniques and equipment. Retina. March 8, 2022. [Epub ahead of print].