PPV: Outcomes in Diabetic, Retinal Detachment Patients

The use of pars plana vitrectomy (PPV) in different patient populations was a topic of discussion during two sessions at AAO 2019.

The first was a paper titled “Retinal Displacement Detected With Fundus Autofluorescence Imaging Following Pneumatic Retinopexy vs. PPV for RD Repair (INTEGRITY Study).” This retrospective study included a consecutive series of eyes with three-month postoperative fundus autofluorescence (FAF) images. Retinal displacement was determined with retinal vessel printing on FAF and was compared for patients who underwent PPV (n = 137 eyes) versus pneumatic retinopexy (PnR; n = 114 eyes) for retinal detachment. In the PPV group, 44.4% of eyes had retinal vessel printing compared to 7.0% for PnR (P<0.0001). Mean displacement was 0.293 ± 0.286 mm for PPV compared to 0.137 ± 0.086 mm for PnR (P=0.008). In eyes with displacement, 97.1% of PnR eyes and 76.5% of PPV eyes had optical coherence tomography interdigitation zone abnormalities and vertical metamorphopsia (P=0.005) compared to 84.0% and 56.2%, respectively, in those without displacement (P=0.03). The authors of the study concluded, “Retinal displacement is more severe with PPV than with PnR and is associated with vertical metamorphopsia.”

The second study presented, “The Influence of Diabetic Retinopathy on the Rate of Cataract Surgery Following PPV,” was a scientific poster presentation. In this retrospective study, researchers evaluated a possible correlation between diabetic retinopathy and the risk of cataract extraction after PPV. Researchers used insurance claims database (PharMetrics; Virginia) information to identify PPV patients between 2006 and 2015. The primary outcome measure was the rate of cataract extraction following PPV. The following confounders were considered: age, sex, region, and Charlson Comorbidity Index. Final analysis included 14,475 patients, of whom 14.1% had cataract extraction. PPV patients had a significantly higher rate of cataract extraction compared to non-PPV patients (32.60% vs. 4.75%). Diabetic patients who underwent PPV had a lower hazard ratio of cataract extraction (3.497) compared to non-diabetic patients (5.193); the difference persisted among all diabetic subgroups with retinopathy (P<0.001).