Despite anatomic success of diabetes-related PPVs, visual outcomes remain poor
According to this meta-analysis, visual outcomes of pars plana vitrectomy (PPV) for diabetic tractional detachment are relatively poor despite successful reattachment, with baseline visual acuity being the only factor showing significant influence over results.
This meta-analysis examined the outcomes of pars plana vitrectomy (PPV) in patients with diabetes. A systematic search of MEDLINE and Embase databases identified 38 studies (3720 eyes) occurring between January 1, 2000, and February 20, 2022, that reported PPV outcomes for diabetic tractional detachments. All included studies were written in English and evaluated at least 25 eyes with a minimum follow-up of 3 months. Primary measured outcomes included the failure of retinal reattachment after a single surgery and final visual acuity (VA). Associations between baseline patient characteristics (e.g., age, diabetes duration, macula status) and surgical maneuvers (e.g., tamponade agents, anti-VEGF use, vitrectomy gauge) were also investigated.
The single-surgery reattachment failure rate was 5.9% (95% CI, 1.4%–8.3%), and the mean final VA was 0.94 logMAR (approximate Snellen equivalent of 6/53). A higher preoperative VA was significantly associated with achieving higher postoperative VA. No other baseline characteristics showed statistical significance.
With a lot of variability and heterogeneity in the reporting of complications across different studies, it is difficult to assess true complication rates. The majority of included studies were retrospective, and it is possible that only case series achieving the best surgical outcomes were prepared for publication. Several studies also used eyes, rather than patients, which can confound the analysis of associated estimates.
This meta-analysis shows that PPV is relatively successful in reattaching the retina for diabetic tractional detachments. However, despite the anatomic success, the final visual outcomes were poor, possibly secondary to retinal ischemia. This data can be helpful in determining appropriate surgical candidates and counseling patients about the potential for limited improvement, especially those with poorer preoperative VA.
Financial Disclosures: Dr. Xuejing Chen discloses no financial relationships.