Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy

To study the preoperative characteristics, complications and outcomes of vitrectomy for proliferative diabetic retinopathy and to identify any factors that may predict visual outcome.

Prospective study of 174 consecutive vitrectomies in 148 patients, with a minimum follow-up of 4 months.

41 (27.7%) patients had a vision of <6/60 in their better eye at presentation. Posterior retinal breaks occurred in 47 (27.0%) eyes. Postoperative complications included vitreous cavity haemorrhage in 37 (22.0%) eyes, retinal detachment in five eyes (3.0%), and rubeotic glaucoma in five eyes (3.0%). 124 (74.7%) eyes improved by at least 0.3 LogMAR units, and 15 (9.0%) worsened by at least 0.3 LogMAR units. 119 (71.7%) eyes had a visual acuity of 6/60 or better, and 27 (16.3%) were counting fingers or worse. Only 16 (11.1%) patients had a vision of <6/60 in both eyes at latest follow-up. Preoperative vision in both the operated eye and the contralateral eye, macular detachment, and long-acting intraocular tamponade were independent predictors of poor postoperative vision, but this model accounted for only a small proportion of the observed variation in outcomes.

Major complications are rare after vitrectomy for proliferative diabetic retinopathy, and >70% of eyes will regain vision of 6/60 or better. Visual outcomes remain unpredictable.