From the Research
A vitrectomy is generally not recommended with an A1c over 10 due to increased surgical risks, and most surgeons prefer patients to have better glycemic control before proceeding with this eye surgery. High blood sugar levels can impair wound healing, increase infection risk, and lead to more surgical complications 1. If your A1c is above 10, your ophthalmologist will likely work with your primary care physician or endocrinologist to improve your diabetes management before scheduling surgery. This might involve adjusting insulin or oral medications, dietary changes, and more frequent blood sugar monitoring.
Key Considerations
- The risk of reaching diabetic vitrectomy increases with poor metabolic control, defined as glycosylated haemoglobin A1c > 75 mmol/mol (~9%) 1.
- Improving your A1c before surgery, even if not to ideal levels, can significantly reduce complications and improve surgical outcomes.
- In urgent cases where the vitrectomy cannot be delayed (such as with severe retinal detachment), surgery might proceed despite high A1c, but with additional precautions and understanding of increased risks.
- The surgeon would need to closely monitor blood sugar levels before, during, and after the procedure.
Recent Evidence
A recent study published in 2023 found that the perioperative use of anti-VEGF reduces the risk of late postoperative vitreous cavity hemorrhage, probably results in lower early postoperative vitreous cavity hemorrhage risk, and may improve visual outcomes 2. However, the primary consideration remains the patient's glycemic control, as evidenced by their HbA1c level.
Surgical Decision-Making
The decision to proceed with vitrectomy in a patient with an A1c over 10 should be made on a case-by-case basis, taking into account the severity of the retinal disease, the patient's overall health, and the potential benefits and risks of the surgery. The use of anti-VEGF agents and other surgical techniques may help mitigate some of the risks associated with vitrectomy in patients with poor glycemic control 3, 4.