Predictors of vision-threatening proliferative diabetic retinopathy in the fellow eye after unilateral vitrectomy: a clinical and imaging-based study

초록

Purpose: To identify clinical and imaging factors associated with vision-threatening proliferative diabetic retinopathy (VT-PDR) in the fellow eye of patients undergoing vitrectomy for VT-PDR in one eye. Methods: This retrospective cohort study included patients with type 2 diabetes mellitus who underwent vitrectomy for VT-PDR—defined as moderate-to-severe vitreous haemorrhage, tractional retinal detachment involving or threatening the macula, or extensive neovascularization—between January 2017 and December 2022. Clinical and imaging data including diabetic retinopathy severity scale (DRSS), presence of predominantly peripheral lesions (PPL), and VT-PDR subtype in the operated eye, were evaluated. Cox proportional hazards model was used as the primary analysis, supported by Kaplan–Meier survival analysis, multivariate logistic regression, and sensitivity analyses. Results: Among 152 patients (mean age 50.1 ± 9.8 years), 96 patients (63.2%) developed VT-PDR in the fellow eye during a mean follow-up of 39.3 ± 23.4 months. Cox regression identified younger age (HR 0.822 per 5-year increase, 95% CI 0.726–0.930, p = 0.002), higher DRSS in the fellow eye (HR 1.033 per point, 95% CI 1.003–1.064, p = 0.029), and PPL (HR 1.819, 95% CI 1.095–3.022, p = 0.021) as independent predictors of progression. Kaplan–Meier curves confirmed significantly shorter time to VT-PDR events in eyes with these risk factors (all p < 0.05). Conclusion: Younger age, advanced DRSS, and PPL are independent risk factors for fellow-eye VT-PDR. Early identification of these risk factors may help guide close monitoring and timely intervention to prevent vision loss in the fellow eye. What is known : Key Messages: Patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) in one eye remain at risk for vision-threatening PDR (VT-PDR) in the fellow eye. Prior studies have mainly assessed systemic factors or DR severity, with limited evaluation of widefield imaging features. What is new : Younger age, higher diabetic retinopathy severity scale (DRSS) scores, and predominantly peripheral lesions (PPL) on widefield imaging independently predict fellow-eye VT-PDR progression. Integrating systemic, clinical, and imaging factors enables improved risk stratification and highlights the need for closer surveillance in high-risk patients. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.

키워드