Corneal Epithelial Defects in Diabetic Patients Following Pars Plana Vitrectomy

TL;DR

This study finds that diabetes increases the risk of corneal defects after eye surgery, with more severe outcomes in patients with proliferative diabetic retinopathy.

Contribution

The study identifies diabetes severity and retinopathy type as factors influencing corneal epithelial defect risk and healing after vitrectomy.

Findings

Diabetic patients had a higher risk of developing corneal epithelial defects after vitrectomy.

Proliferative diabetic retinopathy patients showed a tendency for more severe long-term corneal defects.

No significant difference in initial defect risk was found between proliferative and nonproliferative retinopathy groups.

Abstract

Diabetes mellitus is a known risk factor for corneal epithelial defects (CEDs) after pars plana vitrectomy (PPV), but it is unclear if diabetes severity or specific diabetic risk factors are associated with an increased risk of CED. The purpose of this retrospective cohort study was to identify factors associated with CED and healing time in association with diabetes severity in diabetic patients following PPV. The electronic health record database at University of Florida in Gainesville was queried to identify patients who underwent PPV for retinal detachment (RD) between April 2016 and April 2022. Patient charts were reviewed for clinical data including type of diabetes (if present), diabetes duration and severity, and associated diabetic comorbidities. The main outcome measures included presence of a CED within one month postoperatively, treatment of CED if present, and CED healing time. A total of 637 patients were analyzed, with a total of 243 eyes (26.5%) that belonged to diabetic patients. The diabetic patients were further separated into a proliferative diabetic retinopathy (PDR) group and a nonproliferative diabetic retinopathy (NPDR) group. Diabetes was associated with the development of an initial CED (p=0.040), consistent with existing literature. There was not a significant difference in CED risk when comparing NPDR and PDR patients, although PDR patients tended to have more severe long-term outcomes with persistent corneal epithelial defects (PCEDs). This suggests that PDR patients may still require closer monitoring and earlier intervention for postoperative CED following PPV, as compared to the NPDR patient population.

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