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. Key Messages <Emphasis Type="BoldItalic">What is known</Emphasis> <UnorderedList Mark="Bullet"> <ItemContent> Patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) in one eye remain at risk for vision-threatening PDR (VT-PDR) in the fellow eye. </ItemContent> </UnorderedList> <UnorderedList Mark="Bullet"> <ItemContent> Prior studies have mainly assessed systemic factors or DR severity, with limited evaluation of widefield imaging features. </ItemContent> </UnorderedList> <Emphasis Type="BoldItalic">What is new</Emphasis> <UnorderedList Mark="Bullet"> <ItemContent> Younger age, higher diabetic retinopathy severity scale (DRSS) scores, and predominantly peripheral lesions (PPL) on widefield imaging independently predict fellow-eye VT-PDR progression. </ItemContent> <ItemContent> Integrating systemic, clinical, and imaging factors enables improved risk stratification and highlights the need for closer surveillance in high-risk patients. </ItemContent> </UnorderedList>

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

期刊论文
发表日期：

2026年2月5日

查看全文

Kwang-Eon Choi,
Eungyu Yoon,
Hyun Woo Chung,
Cheolmin Yun

摘要

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.

Key Messages What is known

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.