Ocular Findings, Surgery Details and Outcomes in Proliferative Diabetic Retinopathy Patients with Chronic Kidney Disease

Purpose: We investigated the influence of impaired renal function on fundus characteristics, pars-plana vitrectomy (PPV) details, and outcomes in patients with proliferative diabetic retinopathy (PDR).

Design: A retrospective cohort study.

Methods: We investigated a consecutive series of PDR patients who underwent PPV. The diabetic complications, previous photocoagulation, intravitreal injections before PPV, ocular findings during PPV, surgical details, short-term visual outcome and post-PPV complications were recorded and compared between patients with and without impaired renal function.

Results: 149 patients had normal renal function (67.7%), and 71 (32.3%) patients had impaired renal function; 85.4% of patients were identified with chronic kidney disease (CKD) during the preoperative assessment. Impaired renal function was related to hypertension (3.40[1.58-7.29], p = 0.002), incomplete pan-retinal photocoagulation (PRP) (3.18[1.50-6.72], p = 0.002), severe fibrovascular membrane (8.19[3.43-19.54], p<0.001), and extensive retinal vascular closure (3.40[1.54-7.52], p = 0.002). There was a more frequent occurrence of severe intraoperative bleeding (56.3%, 32.2%, p = 0.001) and a higher percentage of intraocular subretinal fluid drainage (45.1%, 22.1%, p = 0.008) in patients with impaired renal function. The percentage of patients whose visual acuity (VA) increased was similar between the two groups (42.3%, 54.4%, p = 0.34).

Conclusions: In PDR patients, screening for CKD was required before PPV. PDR patients with impaired renal function tended to have more severe ischemic retinal conditions. Comparable PPV outcomes could be obtained in patients with and without impaired renal damage.