Attaining functional levels of visual acuity after vitrectomy for retinal detachment secondary to proliferative diabetic retinopathy

Abstract

Most patients needing diabetic tractional retinal detachment (TRD) surgery are working-age adults that drive and participate in other vision-dependent activities of daily living. We sought to determine the proportion of patients that achieve functional visual acuity (VA) based on the World Health Organization (WHO) definition of 'low vision' (≤ 20/80) and US driving standards (≥ 20/40) after vitrectomy for diabetic TRD. In this 10-year retrospective review, consecutive patients who underwent primary vitrectomy for TRD from proliferative diabetic retinopathy were studied. 240 eyes in 203 patients met criteria for analysis (38 eyes were lost to follow up at 3 months; 68 at 12 months; 146 at 60 months). While most patients (nearly 80%) having TRD surgery had low vision pre-op, almost half attained VA that was > 20/80 five years post-op. Those most likely to achieve significant visual improvement (p < 0.0001) had concomitant vitreous hemorrhage pre-op. Only 6% of eyes met the US minimum driving standard before surgery based on VA compared to 28% after vitrectomy however this study did not examine visual fields which could warrant additional assessment depending on local requirements. In summary, significant gains in visual acuity are seen after vitrectomy for diabetic TRD that can result in functional improvement in activities of daily living.

Figure 1

Patients who underwent vitrectomy with traction retinal detachment with a) pre-op visual acuity (VA) compared to 5 years after surgery for patients with pre-op vision of ≤ 20/80. Mean pre-op VA was 1.9 logMAR (Snellen equivalent 20/1600); 5 years post-op was 1.6 logMAR (Snellen equivalent 20/800) and b) pre-op visual acuity (VA) compared to 5 years after surgery for patients with post-op vision of ≥ 20/40. Mean pre-op VA was 1.2 logMAR (Snellen equivalent 20/300); 5 years post-op was 0.2 logMAR (Snellen equivalent 20/30).