Diabetic Vitrectomy in Young Patients

The age of onset of DM is considered an important factor in the development and progression of DR (Yokoyama et al., Diabetes Care, 20(5): 844–7, https://doi.org/10.2337/diacare.20.5.844 , 1997; Wong et al., Diabetes Care, 31(10): 1985–90, https://doi.org/10.2337/dc08-0580 , 2008). A literature review showed that the prevalence of proliferative diabetic retinopathy (PDR) reached 30% in insulin-dependent DM (IDDM) patients, and the 10-year incidence of vitrectomy for complications by PDR in these patients was 6.4% (Giusti, Pediatr Diabetes, 2(2): 83–93, https://doi.org/10.1034/j.1399-5448.2001.002002083.x , 2001; Ostri et al., Acta Ophthalmol, 92(5): 439–43, https://doi.org/10.1111/aos.12249 , 2014). In young adults, a greater risk of blindness was noted in patients with PDR than in older patients. The risk of retinopathy and vision-threatening retinopathy persisted even after stratification by HbA1c level. Recently, several epidemiologic studies have recognized the growing prevalence of young-onset NIDDM worldwide; this trend is even greater in Asian countries than in the United States (Yoon et al., Lancet, 368(9548): 1681–8, https://doi.org/10.1016/S0140-6736(06)69703-1 , 2006; Fagot-Campagna et al., J Pediatr, 136(5): 664–72, https://doi.org/10.1067/mpd.2000.105141 , 2000). Despite extensive studies on the epidemiology of young-onset DM and its relationship with DR, few reported studies have specifically investigated the prognosis of surgical outcomes and risk factors in young-onset DM patients (Liao et al., BMC Ophthalmol, 20(1): 416, https://doi.org/10.1186/s12886-020-01688-3 , 2020; Kumar et al., Indian J Ophthalmol, 69(11): 3289–95, https://doi.org/10.4103/ijo.IJO_1293_21 , 2021). Important questions are whether young adults who undergo vitrectomy for complications of PDR have different clinical presentations and prognoses than older patients do and whether surgically treated IDDM patients have different clinical features from young-onset NIDDM patients within the same young age group. These issues are discussed through our study in this chapter.