AGE-RELATED DIFFERENCES IN CLINICAL PROFILE AND SURGICAL OUTCOMES OF PROLIFERATIVE DIABETIC RETINOPATHY IN TYPE 2 DIABETES: A COMPARATIVE OBSERVATIONAL STUDY

Abstract

Proliferative diabetic retinopathy (PDR) remains a major cause of preventable blindness worldwide. Although traditionally associated with long-standing diabetes in older adults, an increasing number of younger individuals with type 2 diabetes mellitus (T2DM) present with severe PDR complications requiring vitreoretinal surgery. Limited data exist comparing the clinical characteristics and surgical outcomes between younger and older adults with PDR in the context of T2DM.

Objective: To compare the demographic, clinical, and ocular characteristics of young (<40 years) and older (≥40 years) adults with T2DM presenting with complications of PDR and to evaluate anatomical and functional outcomes after pars plana vitrectomy (PPV).

Methods: A retrospective observational study was conducted on consecutive patients who underwent PPV for PDR-related complications. Baseline systemic parameters, ocular features, surgical indications, intraoperative challenges, postoperative complications, anatomical success, and visual outcomes were compared between the two age groups. Statistical significance was determined using appropriate comparative tests.

Results: Young adults with T2DM demonstrated significantly poorer glycemic control, shorter duration of diabetes at presentation, higher incidence of fibrovascular proliferation, more extensive tractional retinal detachment, and increased prevalence of combined tractional–rhegmatogenous detachment compared with older adults. Postoperatively, younger adults experienced higher rates of recurrent vitreous hemorrhage and membrane proliferation. However, anatomical success after PPV was comparable between groups, although visual recovery was significantly lower in younger adults.

Conclusion: Young adults with T2DM exhibit a more aggressive phenotype of PDR with more complex surgical challenges and poorer functional outcomes despite similar anatomical success. Early screening, strict glycemic management, and timely referral for vitreoretinal intervention are crucial to preventing irreversible vision loss in this vulnerable population.