Pars plana vitrectomy improves retinal reattachment but not visual acuity: JAMA

A recent article published in JAMA Ophthalmology found that pars plana vitrectomy (PPV) improves anatomic outcomes of diabetic tractional retinal detachment (dTRD) but not the functional (Visual) outcome.

TRD is a serious complication that affects approximately 5% of individuals with proliferative diabetic retinopathy, causing a threat to their vision. The team led by Philip McCullough and colleagues undertook this systematic review to determine the anatomic and functional outcomes of PPV for the treatment of TRD in individuals with diabetes.

Data sources, including MEDLINE and Embase, were searched systematically from 2000 to 2022. Eligible studies were those published in English, that reported outcomes of PPV for dTRD, and that included more than 25 eyes with a minimum follow-up of 3 months. A total of 38 studies (3839 eyes) were eligible for analysis and followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction and synthesis.

The main outcomes of the study included the rate of failure of retinal reattachment after one surgery and final visual acuity (VA). The data were pooled using a random-effects model, and the association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated.

The results of the study were:

Overall failure rate of retinal reattachment after one surgery was 5.9% (95% CI, 1.4% - 8.3%), and the mean final VA was 0.94 (95% CI, 0.82 - 1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71).

People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P <.001).

However, on multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes.

The results of this systematic review and meta-analysis suggest that PPV is an effective strategy to achieve retinal reattachment in individuals with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Although final postoperative VA remains low, patients should be counseled on the guarded prognosis of dTRD.

Reference:

McCullough, P., Mohite, A., Virgili, G., & Lois, N. (2023). Outcomes and Complications of Pars Plana Vitrectomy for Tractional Retinal Detachment in People With Diabetes. In JAMA Ophthalmology. American Medical Association (AMA). https://doi.org/10.1001/jamaophthalmol.2022.5817