Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
Predictors of vision-threatening proliferative diabetic retinopathy in the fellow eye after unilateral vitrectomy: a clinical and imaging-based study.
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Choi Kwang-Eon, Yoon Eungyu, Chung Hyun Woo, Yun Cheolmin
Аннотация
PURPOSE: To identify clinical and imaging factors associated with vision-threatening proliferative diabetic retinopathy (VT-PDR) in the fellow eye of patients undergoing vitrectomy for VT-PDR in one eye.
METHODS: This retrospective cohort study included patients with type 2 diabetes mellitus who underwent vitrectomy for VT-PDR-defined as moderate-to-severe vitreous haemorrhage, tractional retinal detachment involving or threatening the macula, or extensive neovascularization-between January 2017 and December 2022. Clinical and imaging data including diabetic retinopathy severity scale (DRSS), presence of predominantly peripheral lesions (PPL), and VT-PDR subtype in the operated eye, were evaluated. Cox proportional hazards model was used as the primary analysis, supported by Kaplan-Meier survival analysis, multivariate logistic regression, and sensitivity analyses.
RESULTS: Among 152 patients (mean age 50.1 ± 9.8 years), 96 patients (63.2%) developed VT-PDR in the fellow eye during a mean follow-up of 39.3 ± 23.4 months. Cox regression identified younger age (HR 0.822 per 5-year increase, 95% CI 0.726-0.930, p = 0.002), higher DRSS in the fellow eye (HR 1.033 per point, 95% CI 1.003-1.064, p = 0.029), and PPL (HR 1.819, 95% CI 1.095-3.022, p = 0.021) as independent predictors of progression. Kaplan-Meier curves confirmed significantly shorter time to VT-PDR events in eyes with these risk factors (all p < 0.05).
CONCLUSION: Younger age, advanced DRSS, and PPL are independent risk factors for fellow-eye VT-PDR. Early identification of these risk factors may help guide close monitoring and timely intervention to prevent vision loss in the fellow eye.
KEY MESSAGES: WHAT IS KNOWN : Patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) in one eye remain at risk for vision-threatening PDR (VT-PDR) in the fellow eye. Prior studies have mainly assessed systemic factors or DR severity, with limited evaluation of widefield imaging features.
WHAT IS NEW: Younger age, higher diabetic retinopathy severity scale (DRSS) scores, and predominantly peripheral lesions (PPL) on widefield imaging independently predict fellow-eye VT-PDR progression. Integrating systemic, clinical, and imaging factors enables improved risk stratification and highlights the need for closer surveillance in high-risk patients.
METHODS: This retrospective cohort study included patients with type 2 diabetes mellitus who underwent vitrectomy for VT-PDR-defined as moderate-to-severe vitreous haemorrhage, tractional retinal detachment involving or threatening the macula, or extensive neovascularization-between January 2017 and December 2022. Clinical and imaging data including diabetic retinopathy severity scale (DRSS), presence of predominantly peripheral lesions (PPL), and VT-PDR subtype in the operated eye, were evaluated. Cox proportional hazards model was used as the primary analysis, supported by Kaplan-Meier survival analysis, multivariate logistic regression, and sensitivity analyses.
RESULTS: Among 152 patients (mean age 50.1 ± 9.8 years), 96 patients (63.2%) developed VT-PDR in the fellow eye during a mean follow-up of 39.3 ± 23.4 months. Cox regression identified younger age (HR 0.822 per 5-year increase, 95% CI 0.726-0.930, p = 0.002), higher DRSS in the fellow eye (HR 1.033 per point, 95% CI 1.003-1.064, p = 0.029), and PPL (HR 1.819, 95% CI 1.095-3.022, p = 0.021) as independent predictors of progression. Kaplan-Meier curves confirmed significantly shorter time to VT-PDR events in eyes with these risk factors (all p < 0.05).
CONCLUSION: Younger age, advanced DRSS, and PPL are independent risk factors for fellow-eye VT-PDR. Early identification of these risk factors may help guide close monitoring and timely intervention to prevent vision loss in the fellow eye.
KEY MESSAGES: WHAT IS KNOWN : Patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) in one eye remain at risk for vision-threatening PDR (VT-PDR) in the fellow eye. Prior studies have mainly assessed systemic factors or DR severity, with limited evaluation of widefield imaging features.
WHAT IS NEW: Younger age, higher diabetic retinopathy severity scale (DRSS) scores, and predominantly peripheral lesions (PPL) on widefield imaging independently predict fellow-eye VT-PDR progression. Integrating systemic, clinical, and imaging factors enables improved risk stratification and highlights the need for closer surveillance in high-risk patients.