Aim:

To determine the factors which influence on the functional outcome of treatment after vitrectomy in patients with proliferative diabetic retinopathy (PDRP).

Material & Methods:

The study involved 56 patients (56 eyes) with PDRP in time of 2 months after vitrectomy. There were included patients with achieved positive anatomical outcome of treatment, the absence of residual macular edema by optical coherence tomography investigations and full transparency of optic media. Indication for vitrectomy in 22 eyes (39,3%) was vitreous hemorrhage without epiretinal tissue in 30 eyes (53,6%) vitreous hemorrhage with epiretinal membranes and tractional retinal detachment threatening or involving the macula, in 4 eyes (7,1%) tractional rhegmatogenous retinal detachment. Initial visual acuity was from light perception to 0,3, and in most cases – 37 eyes (66,1%) were ranged of 0,01 – 0,05. To identify the factors which influence on visual acuity (VA) after vitrectomy, there were assessed the initial somatic status of the patients and clinical condition of the eye, specialties of operation and postoperative period. The degree of neurodegener ative process of the retina was evaluated by the complex of electrophysiological methods and pattern visual evoked potentials (PVEP).

Results:

In terms of 2 months after vitrectomy VA of 18 eyes (32,1%) was from 0,03 to 0,1, in 28 eyes (50%) from 0,12 to 0,3 and 10 eyes (17,9%) from 0,35 to 1,0. Improvment of VA after surgery was statistically significant (χ2=5,18; p=0,02). VA was significantly below than 0,1 in patients with duration of diabetes mellitus (DM) over 30 years (χ2=7,34; p=0,01), and in decompensated diabetes cases (χ2= 8,22; p=0,01). The most important clinical factors which did not allow to achieve VA above 0,1, were: duration of proliferative process above 10 years (χ2=9,78; p=0,00), tractional detachment of the macula before operation (χ2=9,11; p=0,00), the initial VA characterized by light perception (χ2=6,65; p=0,01), development in the early postoperative period exudative reactions (χ2 = 5,18; p=0,02). On the final VA was not significantly influenced panretinal photocoagulation before surgery, vitreous cavity tamponade, development after surgery post vitrectomy vitreous hemorrhage and a number of other factors. Interesting is the fact that initial data of electrophysiological indexes and PVEP characterizing the degree of o neurodegenerative process of the retina were not statistically significant associated with final VA, which is probably connected with insufficient number of observations.

Conclusion:

Visual recovery after vitrectomy in patients with PDRP depends on a number of factors and show the necessity of performing of vitrectomy as early as possible.

Contact Details:

Email: alputienko@yandex.ru
Cell Phone: +380506461192