Available online 3 November 2025

Author links open overlay panel, Introduction

Although the incidence of diabetic retinopathy has declined in recent decades, largely due to advancements in diabetes care, approximately 7% of individuals with diabetes still suffer from proliferative diabetic retinopathy (PDR), with lower prevalence rates observed in European populations (around 2%) [1], [2], [3]. A substantial number of eyes may develop fibrovascular membranes, with the risk of vitreoretinal traction and potential vision loss. In cases where tractional retinal detachment (TRD) or macular traction occurs, pars plana vitrectomy (PPV) may be necessary to prevent irreversible visual impairment. Recent advancements in surgical techniques, along with the use of anti-vascular endothelial growth factor (VEGF) injections administered both preoperatively and intraoperatively, have improved the anatomical success rates of these procedures [4]. Nevertheless, the corresponding improvement in visual acuity often remains limited, as factors such as retinal ischemia significantly influence functional recovery [5]. This case report illustrates the discordance between anatomical improvement and functional visual outcomes in the surgical treatment of diabetic patients, highlighting the importance of a comprehensive understanding of postoperative prognosis and clear communication with patients.

Section snippetsCase report

A 35-year-old patient presented with a four-month history of decreased vision in the left eye. He has been diagnosed with type 1 diabetes since the age of 11. Having been in an irregular residency situation for the last six months, he was unable to maintain his insulin treatment appropriately, resulting in a glycated hemoglobin level of 15%. Best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/200 in the left eye. Fundus examination revealed bilateral proliferative diabetic

Discussion

The yearly incidence of PPV in patients with PDR is estimated to be 6% [6], [7]. However, anatomical improvement following surgery does not always correlate with functional recovery, as illustrated in this case. Preexisting retinal damage, potentially due to macular ischemia and neurodegeneration, combined with long-standing anatomical distortions from vitreoretinal traction, can further limit postoperative visual benefits.

A recent meta-analysis by McCullough and colleagues evaluated the

Disclosure of interest

The authors declare that they have no competing interest.

References (20)H.W. Flynn et al.Pars plana vitrectomy in the early treatment diabetic retinopathy study. ETDRS report number 17. The Early Treatment Diabetic Retinopathy Study Research Group

Ophthalmology

(1992)

D.A. Antonetti et al.Diabetic retinopathy

N Engl J Med

(2012)

J.W.Y. Yau et al.Global prevalence and major risk factors of diabetic retinopathy

Diabetes Care

(2012)

J.Q. Li et al.Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis

Eur J Epidemiol

(2020)

P. Dervenis et al.Anti-vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy. Cochrane Eyes and Vision Group, ed

Cochrane Database Syst Rev

(2023)

P. McCullough et al.Outcomes and complications of pars plana vitrectomy for tractional retinal detachment in people with diabetes: a systematic review and meta-analysis

JAMA Ophthalmol

(2023)

D. Vaideanu et al.Rate of diabetic vitrectomy in a defined geographical part of North East England

Ophthalmic Epidemiol

(2014)

P.P. Storey et al.Visual and anatomical outcomes after diabetic traction and traction-rhegmatogenous retinal detachment repair

Retina

(2018)

E.C. La Heij et al.Clinical variables and their relation to visual outcome after vitrectomy in eyes with diabetic retinal traction detachment

Graefes Arch Clin Exp Ophthalmol

(2004)

B. Gupta et al.Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study

Eye

(2012)

There are more references available in the full text version of this article.

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