Clinical characteristics and surgical outcomes of vitrectomy in young adults with type 1 proliferative diabetic retinopathy

To investigate the clinical characteristics and surgical outcomes of vitrectomy in young adults with type 1 proliferative diabetic retinopathy (PDR), with a focus on the impact of renal function on prognosis. A retrospective cohort study was conducted. Patients aged 18–45 years who underwent vitrectomy for PDR at Jinan Mingshui Eye Hospital from June 2023 to March 2025 were enrolled, with the operated eye as the unit of analysis: 25 patients (31 eyes) with type 1 diabetes mellitus (T1DM) and 35 patients (42 eyes) with type 2 diabetes mellitus (T2DM). Baseline clinical features and surgical outcomes were compared between the two groups, and subgroup analyses stratified by estimated glomerular filtration rate (eGFR) were performed. The mean age of the T1DM group was significantly younger than that of the T2DM group [(28.86 ± 6.62) years vs. (34.78 ± 6.85) years, P = 0.030]; the duration of diabetes was longer [(11.29 ± 4.57) years vs. (8.13 ± 4.02) years, P = 0.011]; eyes of patients with chronic kidney disease (CKD) accounted for 41.9% (13/31) of the T1DM group vs. 11.9% (5/42) of the T2DM group ( P = 0.029); and intraoperative silicone oil tamponade was used in 87.1% (27/31) vs. 69.0% (29/42) of eyes ( P = 0.040). The incidence of postoperative neovascular glaucoma (NVG) was 12.9% (4/31) in the T1DM group, significantly higher than 2.4% (1/42) in the T2DM group ( P = 0.029). Renal function stratification revealed that T1DM patients with eGFR < 30 mL/min/1.73² had the worst postoperative best-corrected visual acuity (BCVA) (1.65 ± 0.82 logMAR), whereas those with eGFR > 60 showed no significant difference from the T2DM group ( P = 0.187); these subgroup findings are based on small numbers and should be interpreted with caution. Correlation analysis showed that glycated hemoglobin ( r = 0.753, P = 0.002), preoperative panretinal photocoagulation ( r = 0.809, P < 0.001), postoperative NVG ( r = 0.620, P = 0.002) and CKD ( r = 0.709, P < 0.001) were positively correlated with postoperative logMAR BCVA in the T1DM group, indicating that higher HbA1c, a history of preoperative PRP, postoperative NVG and CKD were associated with worse postoperative visual acuity. Renal function may be an important factor associated with the prognosis of vitrectomy in young adults with type 1 PDR. In patients with normal renal function, surgical outcomes were similar between T1DM and T2DM; however, T1DM patients with comorbid CKD tended to have the poorest prognosis. These findings are exploratory and require confirmation in larger, longer-term studies. eGFR may be a useful component of preoperative risk assessment.