Treatment History as a Predictor for Change in Visual Acuity After Surgical Correction of Diabetic Retinal Traction Detachment
Keywords:diabetes, traction retinal detachment, bevacizumab, surgery
Introduction. Tractional retinal detachment remains a leading cause of severe, persistent vision loss in those with diabetic retinopathy. The purpose of this study was to investigate factors in treatment history associated with outcomes of surgical repair for diabetic tractional retinal detachments.
Methods. A retrospective, cohort study design was used. Sixty-four eyes that underwent surgical correction for diabetic tractional retinal detachment were retrospectively analyzed. For eyes that received any treatment within three months of surgery, the entire treatment history was recorded and analyzed. Eyes with no recorded treatment or only remote treatment outside of three months prior to surgery were considered treatment naïve.
Results. Of all eyes, 56% (n=36) had received treatment for proliferative diabetic retinopathy in the three months prior to surgery. Among those treated, 50% (n=18) of eyes had both laser and bevacizumab (Avastin) treatments and 44% (n=16) had only bevacizumab injections. One eye received only laser photocoagulation, and one eye received ranibizumab (Lucentis) injections.
Average BCVA for all eyes improved from 1.68 LogMAR (20/1000) pre-operatively to 1.34 (20/400) post-operatively, p=0.0017. Average BCVA in eyes with pre-operative treatment history improved from 1.73 (20/1000) pre-operatively to 1.09 (20/250) post-operatively, p=0.0006. Average BCVA in treatment-naïve eyes was 1.60 (20/800) pre-operatively and 1.66 (20/1000) post-operatively, p=0.638. Eyes treated only with intravitreal injections had an improvement in BCVA from 1.81 (20/1200) pre-operatively to 0.91 (20/160) post-operatively, p=0.006. There was no difference between tamponade agents when comparing mean change in BCVA, p=0.944.
Conclusions. Bivariate analyses suggest there is a relationship between intravitreal injection treatment history and a large improvement in BCVA, and a similar association between combined laser/injection treatment history and improvement in BCVA. These relationships, however, were not present when controlling for confounders in multivariate analysis. There are likely other factors in the patient’s treatment history such as timing, quantity, and order of treatments that play a role in the bivariate association observed in this study.
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Copyright (c) 2022 Zachary Unruh, M.D., O.D., Elizabeth Ablah, Ph.D., MPH, Hayrettin Okut, Ph.D., David M. Chacko, M.D., Ph.D.
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