Proliferative diabetic retinopathy is more severe when it occurs in patients in their 30s than patients in their 50s, a new study published in BMC Ophthalmology shows. The researchers add that their investigation supports the use of pars plana vitrectomy surgery as an effective and safe treatment. However, they say, patients in the younger age group run a greater risk of complications following the procedure than the older group.
The researchers evaluated 58 eyes of 44 patients with an average age of 37.5 years old, and another 58 eyes of 48 patients with an average age of 57.6 years old. The mean duration of diabetes before vitrectomy for the young group was 9.17 years, and in the older group it was 13.98 years. All patients underwent vitrectomy between February 2012 and February 2017 and were followed for at least 24 months.
Within the younger group, 62.1% of eyes developed or saw progression of tractional retinal detachment. With regards to postoperative complications, 24.1% of the younger group and 19% of the older group developed recurrent vitreous hemorrhages. In the younger group, 3.4% experienced retinal detachment, while none from the older group did. Neovascular glaucoma (NVG) was seen in 27.6% of the younger patients and 1.7% of older patients. Finally, 53.4% of younger patients developed nuclear sclerosis, which was seen in only 3.4% of the older patients.
The investigators had particular concern about the NVG numbers, saying “NVG was a main and severe complication besides nuclear sclerosis in young patients, and the incidence of NVG was higher compared to that in senior patients.”
The study speculated about the reason for the differences and suggested that vitreous collagen fibrils change with aging, with the changes including vitreous liquefaction and weakening of vitreoretinal adhesion, which combined with posterior vitreous detachment.
The researchers added that, while they noted no remarkable differences in the occurrence of bilateral proliferative diabetic retinopathy, more of the patients from the younger group had bilateral disease.
“The changes of microenvironment in the retina is similar to glomerular microvessels, and diabetic kidney disorders in young patients often predict a rapid deterioration of the microvascular environment,” the researchers explained.
In fact, the younger age group also showed a higher incidence of kidney disorders and higher diastolic blood pressure than the senior group, the study shows. Among the patients with kidney disorders, young patients had a higher incidence of renal dialysis (6 patients, 13.6%) than senior patients (2 patients, 4.2%), although without significant difference (P =.692). The study did mention several potential limitations, including a small sample size.
Liao M, Wang X, Yu J, et al. Characteristics and outcomes of vitrectomy for proliferative diabetic retinopathy in young versus senior patients. BMC Ophthalmol. (2020) 20:416. doi: 10.1186/s12886-020-01688-3