Treatment History as a Predictor for Change in Visual Acuity After Surgical Correction of Diabetic Retinal Traction Detachment

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. Data on 64 eyes that underwent surgical correction for diabetic tractional retinal detachment were 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 treatments and 44% (n = 16) had only bevacizumab injections. Average best corrected visual acuity (BCVA) for all eyes improved from 1.68 LogMAR (20/1,000) 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 (20/1,000) 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 (20/1,000) post-operatively, p = 0.638. Eyes treated only with intravitreal injections had an improvement in BCVA from 1.81 (20/1,200) 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: There was a relationship between intravitreal injection treatment history and a large improvement in BCVA, and a similar association between combined laser and injection treatment history and improvement in BCVA. These relationships, however, were not present when controlling for confounders in multivariate analysis. There were likely other factors in the patient’s treatment history such as timing, quantity, and order of treatments that played a role in the bivariate association observed in this study.