Vitrectomy with or without routine panretinal photocoagulation for proliferative diabetic retinopathy
DOI:
https://doi.org/10.31288/Ukr.j.ophthalmol.202636875Keywords:
proliferative diabetic retinopathy, vitrectomy, OCT angiography, VEGF, panretinal photocoagulationAbstract
Purpose. To perform a comprehensive comparative assessment of anatomical, functional, microvascular, and angiogenic outcomes of pars plana vitrectomy performed with and without panretinal endophotocoagulation (PRP) in patients with complications of proliferative diabetic retinopathy (PDR), with particular emphasis on retinal ischemia dynamics and vascular endothelial growth factor (VEGF) levels.
Methods. A total of 231 patients (231 eyes) with PDR were included. The main group (121 eyes) underwent vitrectomy without routine PRP, while the control group (110 eyes) underwent vitrectomy combined with PRP. All patients underwent best-corrected visual acuity (BCVA) assessment, intraocular pressure measurement, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA, 12×12 mm), fluorescein angiography, and computer perimetry. VEGF levels in aqueous humor were analyzed in a subgroup of 80 patients (40 from each group) before vitrectomy and during subsequent phacoemulsification with intraocular lens implantation (Phaco+IOL). Follow-up duration was 12 months.
Results. Both groups demonstrated significant postoperative improvement in BCVA with no statistically significant intergroup differences. OCT angiography revealed stabilization or reduction of ischemic zones in the main group and a tendency toward enlargement of ischemic areas in the control group. VEGF concentration decreased significantly after vitrectomy in both groups, with no statistically significant difference between the groups.
Conclusion. Vitrectomy without routine PRP provides comparable functional outcomes and favorable stabilization of retinal ischemia and angiogenic activity. Wide-field OCT angiography and assessment of VEGF-related biomarkers provide objective information on retinal ischemia and angiogenic activity and may assist in individualized postoperative monitoring and treatment decision-making in selected patients with proliferative diabetic retinopathy.
References
Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis. Ophthalmology. 2021;128(11):1580-1591. https://doi.org/10.1016/j.ophtha.2021.04.027
Funatsu H, Yamashita H, Shimizu E, Kojima R, Hori S. Relationship between vascular endothelial growth factor and interleukin-6 in diabetic retinopathy. Retina. 2001;21(5):469-477. https://doi.org/10.1097/00006982-200110000-00009
Noma H, Mimura T, Yasuda K, Shimura M. Role of inflammation in diabetic macular edema. Ophthalmologica. 2014;232(3):127-135.
https://doi.org/10.1159/000364955
Callan A, Heckman J, et al. VEGF in diabetic retinopathy and age-related macular degeneration. Int J Mol Sci. 2025;26(11):4992.
https://doi.org/10.3390/ijms26114992
Suzuki Y, Nakazawa T, Saito M, et al. Proliferative diabetic retinopathy without preoperative pan-retinal photocoagulation is associated with higher levels of intravitreal IL-6 and postoperative inflammation. Int J Retina Vitreous. 2020;6:24.https://doi.org/10.1186/s40942-020-00222-3
Kwon JW, Oh J. Aqueous humor analyses in patients with diabetic retinopathy who had undergone panretinal photocoagulation. J Diabetes Res. 2022;2022:1897344. https://doi.org/10.1155/2022/1897344
Deschler EK, Sun JK, Silva PS. Side-effects and complications of laser treatment in diabetic retinal disease. Semin Ophthalmol. 2014;29(5-6):290-300. https://doi.org/10.3109/08820538.2014.959198
Patel NC, Hsieh YT, Yang CM, et al. Vitrectomy for diabetic retinopathy: a review of indications, techniques, outcomes, and complications. Taiwan J Ophthalmol. 2024;14(4):519-530. https://doi.org/10.4103/tjo.TJO-D-23-00108
Jackson TL, Johnston RL, Donachie PHJ, Sparrow JM, Steel DHW. The Royal College of Ophthalmologists' National Ophthalmology Database study of vitreoretinal surgery: report 6, diabetic vitrectomy. JAMA Ophthalmol. 2016;134(1):79-85.https://doi.org/10.1001/jamaophthalmol.2015.4587
Boned-Murillo A, Albertos-Arranz H, Diaz-Barreda MD, et al. Optical coherence tomography angiography in diabetic patients: a systematic review. Biomedicines. 2022;10(1):88. https://doi.org/10.3390/biomedicines10010088
Moir J, Khanna S, Skondra D. Review of OCT angiography findings in diabetic retinopathy: insights and perspectives. Int J Transl Med. 2021;1(3):286-305. https://doi.org/10.3390/ijtm1030017
Bandello F, Corbelli E, Carnevali A, Pierro L, Querques G. Optical coherence tomography angiography of diabetic retinopathy. Dev Ophthalmol. 2016;56:107-112. https://doi.org/10.1159/000442801
Ra H, Park JH, Baek JU, Baek J. Relationships among retinal nonperfusion, neovascularization, and vascular endothelial growth factor levels in quiescent proliferative diabetic retinopathy. J Clin Med. 2020;9(5):1462. https://doi.org/10.3390/jcm9051462
Sun Z, Yang D, Tang Z, Ng DS, Cheung CY. Optical coherence tomography angiography in diabetic retinopathy: an updated review. Eye (Lond). 2021;35(1):149-161. https://doi.org/10.1038/s41433-020-01233-y
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