Prospective assessment of proliferative diabetic retinopathy with observations of posterior vitreous detachment.
OBJECTIVE
To study the relation between posterior vitreous detachment (PVD) and progression of diabetic retinopathy (DR), based on our observation that proliferative DR is rare in patients with complete PVD.


METHODS
The medical records of 403 patients with diabetes were reviewed for the relation between progressive DR and the status of PVD and HbA(1c) over 3 years. PVD was classified into none, complete PVD with collapse, complete PVD without collapse, partial PVD with a thickened posterior vitreous cortex, and partial PVD without a thickened posterior vitreous cortex. DR was classified into none, simple, preproliferative, or proliferative. When it became more extensive or when laser treatment or vitreous surgery was performed, the DR was considered progressive.


RESULTS
Progression of DR over 3 years occurred in 128/292 (43.8%) eyes with no PVD, 0/14 (0%) eyes with complete PVD with collapse, 2/8 (25%) eyes with complete PVD without collapse, 15/15 (100%) eyes with partial PVD with a thickened posterior vitreous cortex, and 19/74 (25.7%) eyes with partial PVD without a thickened posterior vitreous cortex. Progression of DR occurred significantly more frequently in eyes with partial PVD with a thickened posterior vitreous cortex compared to eyes with complete PVD with collapse (p<0.0001). HbA(1c), did not differ significantly between these two groups (6.9 +/- 0.9% and 7.5 +/- 0.9%, respectively; p = 0.14), although HbA(1c) was significantly higher (p = 0.04) in patients with progressive DR (78 +/- 1.8%) than in patients without progressive DR (7.5 +/- 1.5%).


CONCLUSIONS
Complete PVD is a strong negative risk factor for DR. The PVD status in patients with diabetes should be evaluated.
Ono
Ryuichiro
R
Department of Ophthalmology, Jichi Medical University, Omiya Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
Kakehashi
Akihiro
A
Yamagami
Hiroko
H
Sugi
Norito
N
Kinoshita
Nozomi
N
Saito
Takako
T
Tamemoto
Hiroyuki
H
Kuroki
Masatoshi
M
Lshikawa
San-E
SE
Kawakami
Masanobu
M
D003930:Diabetic Retinopathy / Q000097:blood / Q000150:complications* / Q000473:pathology; D018450:Disease Progression; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D018630:Vitreoretinopathy, Proliferative / Q000150:complications* / Q000473:pathology; D014822:Vitreous Body / Q000473:pathology; D020255:Vitreous Detachment / Q000209:etiology* / Q000473:pathology
D006442:Glycated Hemoglobin