Dr. Maria H. Berrocal’s Study Results ~ Diabetes: The MODERN Plague ~ Early is not Early Enough

Diabetes, known as THE MODERN PLAGUE, affects 366 million people globally. As the disease progresses, it affects a patient’s vision with diabetic retinopathy which is the leading cause of blindness among working age adults worldwide. By 2030, the projection is that 191 million people will have diabetic retinopathy and 56 million with vision threatening retinopathy.

Dr. Maria H. Berrocal’s surgical video shows 27-g used to detach the posterior hyaloid in a young diabetic and the multiple areas of neovascularization present attached to the hyaloid which bleed as the hyaloid is removed. It is these neovascular vessels attaching to the posterior hyaloid in young patients that cause bleeding and traction detachment later on as the hyaloid contracts and pulls on these neovascular fronds.

Younger diabetics actually are more challenged by visual impairment. 42% of Type I diabetics will progress to Proliferative Diabetic Retinopathy in 25 years.

For years, Panretinal Photocoagulation, PRP, has been the gold standard.

Pan-retinal photocoagulation is an effective treatment modality:

  • Reduces Visual Acuity, VA, loss by half but, not ideal
  • Severe Visual Field, VF, defects and night vision reduction
  • Despite treatment, many eyes progress to Tractional Rhegmatogenous Retinal Detachment, and TRRD with dire prognosis
  • 45% of eyes treated with PRP required additional laser in Protocol S at 1 year

Dr. Berrocal presented her prospective study of early vitrectomy in one eye and conventional treatment in the fellow eye to create a real life scenario and long-term follow-up.

Dr. Berrocal’s study included the following:

  • Vitreous Hemorrhage, TRD, PDR
  • 61 eyes – 25 eyes < 50 years of age, 36 eyes > 50 years of age
  • VA, # of interventions, other eye, complications
  • Follow-up – Minimum 5 years, mean 8 years

PATIENT CHARACTERISTICS
50 years or younger – 25 eyes

21-49 mean 40y, duration of DM 18y (52% TRD)

Procedures:
60% Vx/laser
40% Vx/laser/gas                                                                              

> 50 years – 36 eyes
51-72 mean 60y, duration of DM 18y (33%TRD)

Procedures:
72% Vx/laser
28% Vx/laser/gas

                                                                         YOUNGER GROUP <50y (n = 25)                                               
Vx Eye:
88% improved Va, 8% =, 4% dec
Mean post Va 20/80 (8% HM or LP)

Vx eye- Postop procedures:
16% additional laser
8% re-op
12% glaucoma
40% cataract progression

Non-Vx Eye-Conventional Treatment:
24% improved Va, 8%=, 68% dec
Mean post Va 20/400 (20% NLP, 36% HM or less)

Procedures:
72% added laser
60% vitrectomy
72% developed TRD-16% inoperable
16% glaucoma
24% cataract progression
                                                                              OLDER GROUP >50y (n=36)                                                                    
Vx Eye:
86% improved Va, 11% =, 3% dec
Mean post Va 20/80
14% < cf  
47% > 20/100

Vx eye- Postop procedures:                    
8% additional laser
8% re-op
14% glaucoma
44% cataract progression

Non-Operated Eye:
30% improved Va, 21%=, 48% decreased
Mean post Va 20/200 
36% cf, 11% NLP 
30% > 20/100

Procedures:
70% added laser
28% vitrectomy
27% developed TRD – 11% inoperable
16% glaucoma
16% cataract progression

Super Early PPV for Proliferative Diabetic Retinopathy Vx for PDR (n = 10)

  • Va 20/30 – 20/60, mean 20/40
  • Age range 25 – 48, mean 32, F/U 2-4 years
  • 20% macular edema pre-op
  • Vx ~ 25 or 27-gauge, hyaloid detachment, laser ONLY to ischemic areas seen by wide angle angiography

RESULTS SUMMARY
Study Eye:
Post-op Va: 88%
Improved – 33%
Unchanged – 57%
80% Va >20/40                                                            

Procedures required:
10% cataract extraction
10% VEGF inh inj for edema
20% additional laser

Complications:
1 eye post VH cleared
1 eye glaucoma and INV-tx laser

Other Non-Treated Eye:
Unchanged – 80%; Decreased – 20%
80% Va > 20/40

Procedures required:
Added laser – 50%
Vitrectomy – 30%
VEGF inh

Complications:
Subhyaloid heme – 3
TRD – 2

According to Dr. Berrocal, “diabetic visual loss will continue to be the ophthalmic challenge worldwide. Visual Acuity, Va, loss from diabetes affects the most socioeconomically challenged populations. Ideal treatments need to be economically feasible, limit the treatment burden, and stabilize Va long-term with reduced side effects. Through earlier treatment of PDR with Vx, progression to TRD and TRRD can be avoided and many eyes could be saved from these devastating complications long term.”

So, in summary, performing early vitrectomy reduces the need for ancillary treatments and reduces the progression to retinal detachment. This is particularly evident among young diabetics.

Dr. Berrocal can be reached at mariahberrocal@hotmail.com

 

 

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