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Proliferative Diabetic Retinopathy in Nigerians: Treatment Methods, Visual Outcomes, and Predictors of Poor Outcomes
Ogugua Ndubuisi Okonkwo1,2, Adekunle Olubola Hassan1,2,3, Arinze Anthony Onwuegbuna4
1Department of Ophthalmology, Eye Foundation Hospital and Eye foundation Retina Institute, Lagos, Ogun State, Nigeria.
Objective:
To investigate demographics, treatment methods, pre- and post-treatment vision of proliferative diabetic retinopathy (PDR) patients, and predictors of poor visual outcomes.
Materials And Methods:
This is a multicentre chart review of consecutive PDR eyes, investigating vision, presence of vitreous haemorrhage (VH), tractional retinal detachment (TRD), diabetic macular edema (DME), and rubeosis. Rates of good vision (6/60+) and poor vision (< 6/60) and rates of worse, same, or improved vision were the primary outcomes. The secondary outcome was the number of eyes in each treatment category.
Results:
A total of 640 PDR eyes/473 patients were evaluated [334 bilateral eyes (52.2%)/167 patients (35.3%)]. Mean age: 58.9/SD 10.97 years (17-95). Mean symptom duration: 12.8 months. Rates of DME, TRD, VH, TRD with VH, and rubeosis were 12%, 3%, 25.6%, 2.5%, and 15%, respectively. The five treatment categories include intravitreal antivascular endothelial growth factor injections (IVI) alone (392 eyes/61.25%), IVI + retinal laser photocoagulation (86 eyes/13.45%), IVI + cataract surgery (CS) (24 eyes/3.76%), IVI + vitrectomy (V) (109 eyes/17.0%), and IVI + CS + vitrectomy (29 eyes/4.54%). IVI + CS had the highest mean number of intravitreal anti-VEGF use (2.96/SD 4.56) and highest rate of improved vision (62.5%). IVI + vitrectomy had the highest worse vision (29%). IVI alone and IVI + CS had the highest pre- and post-treatment best corrected visual acuity (BCVA). TRD, rubeosis, VH, and no DME eyes had poor mean pretreatment BCVA (< 6/60). Post-treatment mean BCVA improved significantly in VH and DME. Poor pretreatment BCVA, TRD, TRD with VH, and rubeosis were predictors of poor outcomes.
Conclusion:
PDR is a cause of poor vision and associated poor treatment outcomes in Nigerians. Systematic, effective DR screening and retinal laser treatment of high-risk eyes is urgently needed.
