Black patients sustain vision loss while White and south Asian patients gain vision following delamination or segmentation surgery for tractional complications associated with proliferative diabetic retinopathy

Session Details

Session Title: Free Paper Session 6: Vitreoretinal Surgery II

Session Date/Time: Thursday 07/09/2017 | 14:30-16:00

Paper Time: 15:48

Venue: Room 111

First Author: : R.Mastropasqua UK

Co Author(s): :    Y. Luo   L. da Cruz                          

Abstract Details

Purpose:

This retrospective comparative case series aims to determine whether patient ethnicity (White versus South Asian versus Black) is related to the outcome of surgical treatment for traction complications of severe proliferative diabetic retinopathy (PDR).

Setting:

Moorfields Eye Hospital London, UK

Methods:

All patients who underwent vitrectomy with, delamination and/or segmentation for PDR over a 5-year period (2009-2014) were reviewed retrospectively. Patients were divided into White, South Asian or Black groups, and their age, gender, HbA1C and type of diabetes were recorded. A total of 484 patients (253 White, 117 South Asian, 114 Black) were included. Twenty-one patients were excluded due to inadequate documentation. LogMAR Visual acuity (VA) was recorded pre-operatively and six months post surgery. Surgical outcome was classified according to the type and duration of tamponade required postoperatively.

Results:

Pre-operative VA and HbA1C values were similar across all three ethnic groups (p= 0.64 and 0.569, respectively). Change in VA (mean±SD) was 0.41±0.78, 0.14±0.76 and -0.26±0.57 in White, South Asian and Black patient groups respectively (p<0.001). Multiple regression analysis showed that post-op VA was significantly related to race and pre-op VA only (both p<0.001). The Black patient group were more likely to require silicone oil tamponade (p<0.001) and long-term retention of silicone oil (p<0.001) than the White and South Asian patient groups.

Conclusions:

This study demonstrates that Black patients on average lose vision following delamination surgery for traction complications of PDR while White and South Asian patients gain vision. The same group is also at higher risk of retaining silicone more than six months after surgery. This difference remains even when corrected for glycaemic control. This higher risk of vision loss and long-term retaining of silicone oil in Black patients needs further formal investigation and may act as a stimulus to change the treatment paradigm based on race for surgical treatment of traction complications of PDR.

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