A Cohort Study on the Clinical Efficacy of Minimally Invasive Vitrectomy with 23g/25g/27g in Treating Diabetic Retinopathy: Implications for Physical Fitness and Mental Health

Abstract

Objective: This case-control study aimed to evaluate the clinical efficacy of minimally invasive vitrectomy using 23G, 25G, and 27G instruments in treating proliferative diabetic retinopathy (PDR), with a special focus on outcomes related to physical fitness and mental health. Diabetic retinopathy, particularly PDR, severely impacts patients' quality of life, including their physical capabilities and psychological well-being. Methods: Between March 2020 and March 2022, 114 patients diagnosed with PDR were randomized into three groups according to the gauge of minimally invasive vitrectomy performed: 23G, 25G, and 27G. The study assessed improvements in visual acuity, central macular thickness (CMT), intraocular pressure (IOP), best-corrected visual acuity (BCVA), levels of vascular endothelial growth factor (VEGF), and placental growth factor (PIGF). Additionally, the quality of life related to low vision (CLVQOL) and the incidence of postoperative complications were evaluated, emphasizing their implications for physical fitness and mental health. Results: The 27G group demonstrated the highest visual acuity improvement rate (94.74%), surpassing both the 23G (71.05%) and 25G (86.84%) groups, with significant differences observed between the 23G group and the others (P<0.05), but not between the 25G and 27G groups (P>0.05). The 27G procedure also featured the shortest operation time and the greatest postoperative visual acuity improvement but incurred the highest costs (P<0.05). Postoperative measurements showed significant reductions in CMT and serum levels of VEGF and PIGF, with the 25G and 27G groups experiencing notably better outcomes than the 23G group (P<0.05). Improvements in distance vision, mobility, light perception, adaptation ability, daily living skills, and fine reading ability post-surgery were significantly better in the 25G and 27G groups compared to the 23G group (P<0.05). The incidence of postoperative complications was significantly lower in the 25G (13.16%) and 27G (5.26%) groups compared to the 23G group (34.21%) (P<0.05). Conclusion: The study concludes that 25G and 27G minimally invasive vitrectomy offers superior efficacy over 23G vitrectomy in treating PDR, significantly enhancing visual acuity and retinal function, reducing complication rates, and thereby potentially improving patients' physical fitness and mental health. The 27G technique, in particular, matches the efficacy of the 25G with the added benefits of shorter operation times and lower complication risks, indicating a preferable option for enhancing the quality of life and well-being in patients with PDR, including those prioritizing physical fitness and mental health recovery.