CLINICAL CHARACTERISTICS OF PROLIFERATIVE DIABETIC RETINOPATHY (PDR) PATIENTS WITH VITREOUS HEMORRHAGE AT CIPTO MANGUNKUSUMO HOSPITAL
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Abstract
Introduction: Proliferative Diabetic retinopathy is the most common cause of blindness in adults. In the management of vitreous hemorrhage, vitrectomy is the main choice and also laser photocoagulation with or without anti-VEGF administration as additional therapy. This study aims to determine the number of patients, demographic characteristics, clinics, risk factors, distribution of treatment, and treatment outcomes for PDR patients with vitreous hemorrhage at Cipto Mangunkusumo Hospital.
Methods: This study was retrospective descriptive study conducted from January 2020 to October 2022 who met the inclusion criteria. Population in this study were patients at Cipto Mangunkusumo Hospital with PDR accompanied by vitreous hemorrhage. Data shown in the table were mean (standard deviation) and number (percentage) based on the type of the data.
Result: A total of 146 patients with the diagnosis of Proliferative Diabetic Retinopathy (PDR) with vitreous hemorrhage. Majority of subjects were men (60,9%), diagnosed with DM more than 10 years (63,0%) with another systemic risk factor. The most common clinical characteristics found visual acuity at the initial visit <3/60 (80,8%), diagnosed phakia (78,9%), retinal detachment (85,3%), grade 2 vitreous hemorrhage (80,8%). The majority of eyes underwent vitrectomy (90,44%), Anti-VEGF injections (22,92%), Laser PRP (11,46 %), Phacoemulsification pre and post- vitrectomy as adjuvant treatment. The condition of the vitreous was clear after vitrectomy (99,1%). Mean visual acuity before vitrectomy is 2.10 (1.80 – 2.50), while mean visual acuity after vitctomy was 1.00 (1.30 – 2.40), with a difference in initial and final visual acuity of -0.10 (-0.50 – 0.60).
Conclusion: Majority of study subjects were men with an age range of 25-77 years. Vitrectomy as the main treatment combined with intravitreal injection of anti-VEGF, laser PRP as adjuvant treatment. In nearly all cases, vitreous hemorrhage was clear after vitrectomy treatment. Visual acuity after vitrectomy shows progress even though in some cases there was no improvement.
Keywords
Diabetic Retinopathy, Proliferative Diabetic Retinopathy, Vitreous Hemorrhage, Vitrectomy.
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References
2. Jena S, Tripathy K. Vitreous Hemorrhage. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
3. Darajati IT, Wardhana FS, Sasongko MB, Supanji S, Widayanti TW, Agni AN. Vitreous Hemorrhage in Dr.Sardjito General Hospital. Ophthalmologica Indonesiana. 2017;42(3).
4. Metita M, Sovani I, Kartasasmita A, Iskandar E, Virgana R. Surgical Approach In Vitreous Hemorrhage. International Journal of Retina. 2017(1):12-6%V 1.
5. Petrovic N, Todorovic D, Sreckovic S, Sarenac-Vulovic T, Petrovic Janicijevic M, Paunović S, et al. The influence of intravitreally applied triamcinolone acetonide on vitreal hemorrhage resorption and visual acuity in patients with proliferative diabetic retinopathy. Srpski arhiv za celokupno lekarstvo. 2017;146:131-.
6. Razief Fitri MA, Yudantha AR. PARS PLANA VITRECTOMY FOR VITREOUS HEMORRHAGE IN CIPTOMANGUNKUSUMO HOSPITAL. International Journal of Retina. 2021(2):99%V 4.
7. Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev. 2016;37(3):278-316.
8. Wang CY, Cheang WM, Hwang DK, Lin CH. Vitreous haemorrhage: a population-based study of the incidence and risk factors in Taiwan. Int J Ophthalmol. 2017;10(3):461-6.
9. Ansari P, Tabasumma N, Snigdha NN, Siam NH, Panduru RVNRS, Azam S, et al. Diabetic Retinopathy: An Overview on Mechanisms, Pathophysiology and Pharmacotherapy. Diabetology. 2022;3(1):159-75.
10. Zou W, Ni L, Lu Q, Zou C, Zhao M, Xu X, et al. Diabetes Onset at 31-45 Years of Age is Associated with an Increased Risk of Diabetic Retinopathy in Type 2 Diabetes. Sci Rep. 2016;6:38113.
11. Bek T. Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema. Diabetologia. 2020;63(11):2462-70.
12. Bansal P, Gupta R, Kotecha M. Frequency of diabetic retinopathy in patients with diabetes mellitus and its correlation with duration of diabetes mellitus. Medical Journal of Dr DY Patil University. 2013;6(4):366-9.
13. Lind M, Pivodic A, Svensson AM, Ólafsdóttir AF, Wedel H, Ludvigsson J. HbA(1c) level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. Bmj. 2019;366:l4894.
14. Jeng C-J, Hsieh Y-T, Lin C-L, Wang IJ. Effect of anticoagulant/antiplatelet therapy on the development and progression of diabetic retinopathy. BMC Ophthalmology. 2022;22(1):127.
15. Stewart MW, Browning DJ, Landers MB. Current management of diabetic tractional retinal detachments. Indian Journal of Ophthalmology. 2018;66(12):1751-62.
16. Chatziralli I, Loewenstein A. Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature. Pharmaceutics. 2021;13(8).
17. Zong Y, Gao QY, Hui YN. Vitreous function and intervention of it with vitrectomy and other modalities. Int J Ophthalmol. 2022;15(6):857-67.
18. Liao M, Wang X, Yu J, Meng X, Liu Y, Dong X, et al. Characteristics and outcomes of vitrectomy for proliferative diabetic retinopathy in young versus senior patients. BMC Ophthalmology. 2020;20(1):416.