Clinical Ophthalmology (Jan 2024)
Long-Standing Macula-Involving Diabetic Tractional Retinal Detachments with Good Visual Acuity: How Should We Manage These Patients?
Abstract
Ryan B Rush,1– 4 Sloan W Rush1,2 1Panhandle Eye Group, Amarillo, TX, USA; 2Department of Surgery, Texas Tech University Health Science Center, Amarillo, TX, USA; 3Instituto de la Visión– Hospital La Carlota, Montemorelos, Nuevo León, México; 4Southwest Retina Specialists, Amarillo, TX, USACorrespondence: Ryan B Rush, Southwest Retina Specialists, 7411 Wallace Blvd, Amarillo, TX, 79106, USA, Tel +1 806 351-1870, Email [email protected]: We assess the merits of pars plana vitrectomy (PPV) in subjects with good visual acuity (VA) and a chronic macula-involving tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR).Methods: A retrospective review of medical records was undertaken. Subjects were divided into 1) a Study Group of subjects who underwent prompt PPV and 2) a Control Group of subjects in which PPV was deferred in favor of less invasive treatment options or observations. Both study and control subjects had a baseline Snellen VA of ≥ 20/50 and a PDR-associated macula-involving TRD of > 6 months duration with a minimum follow-up of 12-months.Results: There were 58 patients analyzed over an average follow-up period of 27.6 (± 7.1) months. The change in VA was similar in the Study Group compared to the Control Group (p=0.94) with both groups losing about three lines of VA during the study period (− 0.30 ± 0.52 logMAR). Although the rates of maintaining ≥ 20/200 Snellen VA and ≥ 20/50 Snellen VA were similar in the Study Group compared to the Control Group (p=0.55 and p=0.28, respectively), the Study Group had more subjects gaining ≥ 2 lines of VA during the study period (p=0.002).Conclusion: Patients presenting with good VA and a PDR-associated macula-involving TRD of > 6 months were more likely to gain ≥ 2 lines of VA when PPV was performed at baseline compared to PPV deferral until further deterioration occurred.Keywords: chronic tractional retinal detachment, diabetic vitrectomy, good visual acuity
