Need for PPV in Diabetic Patients Indicates Systemic Worsening and Elevated Risks of Severe Complications

These findings underscore the need for monitoring and management of systemic health in diabetic patients undergoing PPV for advanced DR, authors of a recent study concluded. Photo: Wikimedia Commons/Journal of Ophthalmology, Liu X et al. Click image to enlarge. Many patients with type 2 diabetes keep their HbA1c levels well maintained and experience few if any complications from the condition. Once ocular involvement manifests, however, it’s a sign that their systemic health has worsened. Still, patients with diabetic retinopathy (DR) can be capably managed with both systemic and intravitreal meds and kept generally safe. But at the point that pars plana vitrectomy (PPV) is indicated, the patient’s glycemic control and overall health has likely deteriorated to such a point as to put them at higher risk for the most severe complications of diabetes: mortality, myocardial infarction (MI), stroke and amputation.Authors of a recent study found that these patients have an approximately 30% higher risk of mortality at five years compared to those with DR not requiring PPV, and the risks of MI, stroke and amputation are elevated by approximately 50%, 54% and 110%. The findings were reported in Ophthalmology Science.The study included 9,081 diabetes patients who underwent PPV for DR, 363,116 with DR but no history of PPV, 92,645 without DR and 3.2 million healthy individuals, all aged 18 years and older. Primary outcome measures were the hazard ratios for mortality, MI, stroke and amputation at one, three and five years following PPV compared to the control groups.When compared to diabetic patients without DR and healthy patients, the PPV cohort faced higher risk of each health outcome analyzed at intervals of one, three and five years. Compared to DR patients not requiring PPV, the PPV cohort had a higher risk at one year for stroke and amputation. At three years, the risks for MI, stroke and amputation significantly elevated. At five years, the risks for mortality, MI, stroke and amputation were all significantly higher.“These findings indicate a substantial burden of systemic vascular complications in patients with advanced diabetic eye disease requiring surgical intervention, highlighting the need for comprehensive management strategies that address both ocular and systemic health risks in this population,” the authors concluded. This could include communicating these risks to patients, encouraging close follow-up with primary care and specialty providers, and corresponding with those providers to optimize systemic management. Click here for the journal source. Jester DA, Chauhan MZ, Hussain ZS, et al. Real-world analysis exploring risk of systemic health events and morality following vitrectomy for diabetic retinopathy. Ophthalmol Sci. July 2, 2025. [Epub ahead of print.]