Collaborative clinical research led by the Department of Ophthalmology, Odense University Hospital, Denmark has indicated that approximately 12.0% of type-1 diabetes patients over a 17-year period under-went vitrectomy at least once. The study found that the mean age and diabetes duration at first vitrectomy were 29.8 years and 22.9 years, respectively, and that 64.1% of those under-going the surgical procedure were male. In a multivariable regression analysis, researchers reported on a number of measurements, the most significant of which was HbA1c levels which indicated a hazard ratio of 1.72 per 1% increase, while diabetic retinopathy had a hazard ratio of 2.85 and 6.07 for mild and moderate/severe diabetic retinopathy vs. none, respectively. Other variables analyzed included baseline age, sex, diabetes duration, arterial blood pressure, body-mass index (BMI), vibration perception threshold and urinary albumin excretion rate, none of which appeared to be statistically relevant. The research concluded that vitrectomy is a relatively common procedure in young type-1 diabetes patients with poor glycaemic control.
The research was undertaken to build a more comprehensive understanding of the incidence of vitrectomy among diabetic patients thereby equipping clinicians with improved data to guide clinical care following ocular examination. According to the Danish research group, the research represented the longest prospective study to examine how frequently vitrectomy is required in young type-1 diabetic patients. Highlighting a 12% incidence of vitrectomy before the age of 30 years in such patients underscores the importance of modifiable risk factors, especially glycaemic control.
The findings were made by possible through the availability of data from a 1995 study on microvascular complications in paediatric type-1 diabetes, carried out across Denmark. In 2012, the research group applied to the Danish National Patient Registry for data on these original participants in order to gather data on the rate of vitrectomy. Of the 324 people participating in the prospective study 4.0% had died and 1.9% had emigrated from Denmark over the 17-year follow-up period. Among the 12.0% that underwent vitrectomy, the surgical indications were unclearing vitreous haemorrhage (43.6%) and tractional retinal detachment (56.4%). Commenting on the data in their publication in the journal Diabetic Medicine (DOI: 10.1111/dme.12628), the researchers stated that, “Despite the very young age and the minimal comorbidity at baseline, more than one in 10 people needed vitrectomy at least once during the 17-year follow-up, with the strongest modifiable risk factor being poor glycaemic control. This could be a reflection of the improved surgical and visual outcomes seen in the later years leading to earlier decisions to operate and possibly a lower need for pan-retinal photocoagulation.”