Proliferative Diabetic Retinopathy in Nigerians: Treatment Methods, Visual Outcomes, and Predictors of Poor Outcomes.

Abstract

Objective: To investigate demographics, treatment methods, pre- and post-treatment vision of proliferative diabetic retinopathy (PDR) patients, and predictors of poor visual outcomes.

Materials and methods: This is a multicentre chart review of consecutive PDR eyes, investigating vision, presence of vitreous haemorrhage (VH), tractional retinal detachment (TRD), diabetic macular edema (DME), and rubeosis. Rates of good vision (6/60+) and poor vision (< 6/60) and rates of worse, same, or improved vision were the primary outcomes. The secondary outcome was the number of eyes in each treatment category.

Results: A total of 640 PDR eyes/473 patients were evaluated [334 bilateral eyes (52.2%)/167 patients (35.3%)]. Mean age: 58.9/SD 10.97 years (17-95). Mean symptom duration: 12.8 months. Rates of DME, TRD, VH, TRD with VH, and rubeosis were 12%, 3%, 25.6%, 2.5%, and 15%, respectively. The five treatment categories include intravitreal antivascular endothelial growth factor injections (IVI) alone (392 eyes/61.25%), IVI + retinal laser photocoagulation (86 eyes/13.45%), IVI + cataract surgery (CS) (24 eyes/3.76%), IVI + vitrectomy (V) (109 eyes/17.0%), and IVI + CS + vitrectomy (29 eyes/4.54%). IVI + CS had the highest mean number of intravitreal anti-VEGF use (2.96/SD 4.56) and highest rate of improved vision (62.5%). IVI + vitrectomy had the highest worse vision (29%). IVI alone and IVI + CS had the highest pre- and post-treatment best corrected visual acuity (BCVA). TRD, rubeosis, VH, and no DME eyes had poor mean pretreatment BCVA (< 6/60). Post-treatment mean BCVA improved significantly in VH and DME. Poor pretreatment BCVA, TRD, TRD with VH, and rubeosis were predictors of poor outcomes.

Conclusion: PDR is a cause of poor vision and associated poor treatment outcomes in Nigerians. Systematic, effective DR screening and retinal laser treatment of high-risk eyes is urgently needed.