Race may affect acuity outcomes of pars plana vitrectomy

Jackson, MS-A study that compared the outcomes of pars plana vitrectomy performed to treat complications of proliferative diabetic retinopathy (PDR) based on racial differences among Caucasians, Choctaw Indians, and African Americans found that race might affect outcomes.

Dr. Wafapoor conducted a retrospective chart review of 200 patients who had a diagnosis of PDR and underwent pars plana vitrectomy from January 1998 to December 2004. Patients were included if they had complications of PDR that required pars plana vitrectomy, a minimum of 3 months of follow-up, and had not undergone previous vitreoretinal surgery, according to Dr. Wafapoor, who is assistant professor of ophthalmology, department of ophthalmology, vitreo-retinal service, University of Mississippi Medical Center, Jackson, MS.

All vitrectomies were performed at the Department of Ophthalmology, University of Mississippi Medical Center. The investigators recorded the indication for surgery, the preoperative and postoperative VA levels, postoperative complications, and the number of additional surgeries required.

Multiple articles have documented the existence of racial and ethnic disparities in health and health care with an objective of improving the quality of care as well as an attempt to narrow racial disparities.

There were four major indications for surgery: vitreous hemorrhage, tractional retinal detachment, neovascular glaucoma, and progressive fibrovascular proliferation. Vitreous hemorrhage was the most common and occurred in 42%, 75%, and 67.9% of African Americans, Caucasians, and Choctaw Indians, respectively. Tractional retinal detachment occurred in 44%, 21.7%, and 33.5%, respectively. Neovascular glaucoma developed in 1%, 1%, and 0%, respectively. Progressive fibrovascular proliferation occurred in 8%, 1%, and 1%, respectively.

One noteworthy finding, according to Dr. Wafapoor, was the higher rate of tractional retinal detachment in African American patients (p < 0.005). Gas and silicone oil tamponades were used at a higher rate in African American patients (50% compared with 20% of Caucasians and 25% of Choctaw Indians, p < 0.0001).

"These two factors substantiate the idea that African American patients may present with more severe diabetic retinopathy," Dr. Wafapoor commented.

Of particular concern in the analysis were the changes in VA.

"The improvement in VA, while it did not reach significance, was slightly higher in Caucasian patients. However, and more importantly, a higher rate of worsening of VA was seen in African American and Choctaw Indian patients," Dr. Wafapoor reported. In addition, more African Americans and Choctaw Indians had light perception and no light perception vision postoperatively.

Finally, the Choctaw Indians had a rate of reoperation (35.7%) that was more than double that of Caucasian and African American patients (16.7% and 17%, respectively, p = 0.069).