Risk factors for progression of diabetic retinopathy after panretinal photocoagulation

  Background  Diabetic retinopathy (DR) still has a high risk of progression after panretinal photocoagulation (PRP) therapy.

  Objective  To investigate the systemic and ocular factors associated with DR progression after PRP.

  Methods  This study was a single-center retrospective study. Patients who received PRP treatment for DR from January 1, 2017 to June 1, 2021 in the Department of Ophthalmology of the First Medical Center of Chinese PLA General Hospital were selected, and then they were divided into DR-progressive group and DR-stable group. The potential risk factors were analyzed by univariate and multivariate logistic regression to predict progression.

  Results  A total of 289 patients were finally included, with an average age of (51.1 ± 11.4) years, and 59.5% of them were male. Systemic complications were mainly hypertension (74.4%), followed by chronic kidney disease (CKD) (38.1%), hyperlipidemia (30.8%) and coronary heart disease (12.1%). There were 163 cases in the DR-progressive group, and the incidence of DR progression was 56.4%. According to univariate logistic regression, 16 potential risk factors for DR progression were screened, which were mainly reflected in age, baseline visual acuity, renal function, lipid metabolism, and anemia (P<0.05). Incorporating these variables into logistic regression revealed that CKD (OR=3.257, 95% CI: 1.671-6.351), baseline best corrected vision (LogMAR) (OR=6.149, 95% CI: 1.770-21.358) and age (OR =1.034, 95% CI: 1.003-1.067) were risk factors for DR progression, indicating that the higher stage of CKD, the worse baseline vision, and age less than 50 years were associated with higher risk of DR progression. Among them, the prediction performance of CKD stage was better, the area under the ROC curve was 0.784 (95% CI: 0.559-0.990), the cut-off point was CKD stage = 1 stage with the sensitivity of 71.2% and the specificity of 82.5%.

  Conclusion  Worse renal function, lower baseline vision and age less than 50 years are independent risk factors with good prediction efficiency for DR progression after PRP.