Specific clinical manifestations of proliferative diabetic retinopathy in young patients and assessment of technical challenges of endovitreal surgery and its outcomes

BACKGROUND: The number of young patients with type 1 diabetes mellitus is steadily increasing in all countries of the world. Technical features of performing vitrectomy for proliferative diabetic retinopathy in patients with type 1 diabetes mellitus have not been sufficiently studied. The need for their study is very urgent, since the number of such patients is constantly increasing, the information obtained will help to avoid intra- and postoperative complications that may arise during vitrectomy. AIM: The work aimed to study the morphological and functional features of proliferative diabetic retinopathy in young patients with type 1 diabetes mellitus and to assess the technical challenges of endovitreal surgery and its outcomes. METHODS: The study included unselected young patients with proliferative diabetic retinopathy and type 1 diabetes mellitus who were indicated for vitreoretinal surgery. A total of 32 patients (55 eyes) aged 18 to 46 years were selected; best corrected visual acuity with light projection was up to 0.3. A three-port pars plana endovitreal procedure was performed in all patients. RESULTS: A total of 48 eyes had dense fused posterior hyaloid and internal limiting membranes and affected vessel hemorrhages tending toward re-occur when they were separated. Flat fusions of the preretinal membranes, retinal vessels, and retina were observed in 25 eyes. These characteristics prolonged endovitreal surgery. All procedures were completed with silicone oil tamponade. On day 1, 40 eyes had small preretinal hemorrhages at the posterior pole. Large preretinal hemorrhages developed in 15 eyes. One month after silicone oil removal, best corrected visual acuity in 36 eyes increased to 0.2–0.8. CONCLUSION: Significant technical challenges of vitrectomy were noted in all patients and were caused by a severe damage to the vitreomacular interface. One month after silicone oil removal, proliferative diabetic retinopathy was stabilized in 96% of the eyes.