Retrospective analysis of vitreoretinal surgery outcomes in diabetic retinopathy

Purpose. To analyze the clinical and functional results of vitreoretinal operations in patients with type II diabetes mellitus and diabetic retinopathy (DR).
Materials and methods. A retrospective analysis of vitreoretinal surgery outcomes in DR was performed in 421 patients (421 eyes), with type II diabetes mellitus and DR, with no previous history of retinal laser coagulation. The follow-up period was at least 4 years. Patients were divided into two groups depending on the postoperative course of the disease. Group I included 338 patients (338 eyes) with a single vitreoretinal intervention followed by stabilization of the pathological changes over the whole follow-up period. Group II consisted of 83 patients (83 eyes), ca. 20 % of the cohort, with repeated vitreoretinal operations required by DR progression. In addition, the groups were analyzed according to the best corrected visual acuity (BCVA).
Results. The initial BCVA of less than 0.1 was noted in 69 % of cases in Group I with a single surgery while that in Group II claimed 80.7 % of cases. By the 6th month, BCVA values revealed an average increase from 0.05 to 0.20 in Group I and an average increase from 0.05 to 0.08 in group II. In Group I, at the end of the follow-up the mean BCVA remained stable and was higher than before the operation, while in Group II it dropped and remained significantly lower than in Group I. Also, by the end of the follow-up the patients given a single vitreoretinal intervention whose BCVA was below 0.1 showed an increase in the mean BCVA value, whilst those with initial BCVA of 0.4–0.6 showed BCVA stabilization. Patients with repeated operations and initial BCVA below 0.1 showed no noticeable BCVA changes but those with BCVA 0.1–0.6 revealed a drop.
Conclusions. Modern technologies of vitreoretinal surgery of severe DR stages ensure a stable anatomical outcome following a single surgery in 80 % of cases, a stable functional result in 59 % of cases. In 20 % of cases, relapses and the need for repeated operations are associated with the initially more pronounced diabetic alterations of the retina, probably due to the patients’ late referral. Timely detection of DR and referral of such patients to a specialized ophthalmology center is a necessary task.

1. Shestakova M.V., Vikulova O.K., Zheleznyakova A.V., Isakov M.A., Dedov I.I. Diabetes epidemiology in Russia: what has changed over the decade? Terapevticheskiy arkhiv. 2019; 91 (10): 4–13 (in Russian). doi: 10.26442/00 403660.2019.10.000364

2. Astakhov Yu.S., Shadrichev F.E., Lisochkina A.B. Retinal laser coagulation in the treatment of diabetic retinopathy. Klinicheskaya meditsina. 2000; 1 (1): 15–8 (in Russian).

3. Neroev V.V., Zajceva O.V., Mikhajlova L.A. Incidence of diabetic retinopathy in the Russian Federation according to Federal statistics. Rossian ophthalmological journal. 2018; 11 (2): 5–9 (in Russian). doi: 10.21516/2072-0076-2018-11-2-5-9

4. Moshetova L.K., Nesterov A.P., Egorov E.A., eds. Clinical recommendations. Ophthalmology. Moscow: GEOTAR-Media; 2006 (in Russian).

5. Early Treatment Diabetic Retinopathy Study Research Group Techniques for scatter and local photocoagulation treatment of diabetic retinopathy. Early Treatment Diabetic Retinopathy Study Report Number 3. Int. Ophthalmol. Clin. 1987; 27 (4): 254–64. doi: 10.1097/00004397-198702740-00005

6. Balashevicha L.I., ed. Eye manifestations of diabetes. Sankt-Peterburg: SPbMAPO; 2004 (in Russian).

7. Fedorov S.N., Metaev S.A., Shkovorchenko D.O. Complex surgical treatment of nonproliferative and early proliferative diabetic retinopathy. Oftal'mokhirurgiya. 1999; 4: 43–8 (in Russian).

8. Sdobnikova S.V., Stolyarenko G.E., Fedorov A.A., Marchenko N.R. Regarding the role of posterior hyaloid membrane in the pathogenesis and surgery of proliferative diabetic retinopathy. Vestnik oftal'mologii. 1996; 122 (4): 5–7 (in Russian).

9. Babaeva D.B., Shishkin M.M. Dependence of visual function recovery on the time of surgical intervention in patients with diabetic vitreopapillary traction syndrome. Sovremennye tekhnologii v oftal'mologii. 2019; 26 (1): 26–8 (in Russian). doi: 10.25276/2312-4911-2019-1-26-28

10. Sdobnikova S.V., Mazurina N.K., Stolyarenko G.E., et al. Current approach to the treatment of proliferative diabetic retinopathy. RMZh. “Klinicheskaya oftal'mologiya”. 2002; 3 (3): 99–104 (in Russian).

11. Trubina O.M., Kanyukov V.N., Kazennov A.N., Kazennova N.A. Experience of surgical treatment of proliferative diabetic retinopathy. Byulleten' VSNTs RAMN. 2016; 1 (6): 118–21 (in Russian). doi.org/10.12737/23791

12. Khudyakov A.Yu., Zhigulin A.V. Analysis of the results of our own experience of treating proliferative diabetic retinopathy. Sovremennye tekhnologii v oftal'mologii. 2019; 26 (1): 218–21 (in Russian). doi: 10.25276/2312-4911-2019-1-218-221

13. Shkvorchenko D.O., Kashtan O.V., Srednyakov V.A., Afanas'ev V.V., Osokin I.G. Results of surgical treatment of complicated forms in proliferative diabetic retinopathy under conditions of controlled artery hypotony. Oftal'mokhirurgiya. 2011; 1: 49–52 (in Russian).

14. Khuthaila M.K., Hsu J., Chiang A. Postoperative vitreous hemorrhage after diabetic 23-gauge pars plana vitrectomy. Am J Ophthalmol. 2013; 155 (4): 757–63. doi: 10.1016/j.ajo.2012.11.004

15. Konovalova K.I., Shishkin M.M. Step-by-step surgical treatment of advanced proliferative diabetic retinopathy and complicated primary cataract. Sovremennye tekhnologii v oftal'mologii. 2020; 1: 160–4 (in Russian). doi.org/10.25276/2312-4911-2020-2-160-164

16. Babaeva D.B., Shishkin M.M. Timely vitreoretinal surgery in patients with vitreopapillary traction syndrome in proliferative diabetic retinopathy. Sovremennye tekhnologii v oftal'mologii. 2018; 1: 39–40 (in Russian).