Our study found an increase in quality of life one month after vitrectomy in each group, and increased up to 16 points when compared pre-surgical vision quality versus three months after vitrectomy evaluation, in patients with advanced diabetic retinopathy, 9 points in patients with rhegmatogenous retinal detachment, and six points in patients undergoing surgery for other reasons. The type of air/gas tamponade showed a better quality of life score compared to those in which silicone was used, this may be because its use is generally limited to the most complex retinal disease cases who perceive a lower quality of life related to vision; additionally, a correlation was identified between older age and an improvement in the quality-of-life score after surgery, particularly in patients with diabetic retinopathy.
These findings contrast with the reported by Okamoto and his group , who applied the test to 51 patients diagnosed with diabetic retinopathy before undergoing surgery and three months later; the score reported in vitreous haemorrhage was 51.2 to 62.3, tractional retinal detachment 61.1 to 70.3 and excessive macular traction 55.2 to 59.4. The subscales that reported significant improvement after surgery were general vision, near and distance activities, social function, mental health, role difficulty, driving, and peripheral vision. However, no correlation was shown with age, duration of diabetes, HbA1C levels, or fasting glucose. In our study, it was observed that the preoperative score was below the reported by Okamoto (43.00); however, the results after surgery are similar (57.51 and 59.17), indicating a significant improvement in the quality of life of patients undergoing vitrectomy in our country.
The quality-of-life total score in cases of rhegmatogenous retinal detachment has been reported at 80 points in women and 74.7 in men with follow-up at 6 months; according to Smeretschnig, the items with the greatest difference concerning normal controls were general vision, mental health, social functionality, driving, and colour vision . On the other hand, a group reported this difference at 3 months of operated patients versus controls, in near activities, peripheral vision, dependency, and mental health , whose findings coincide with those of Du and his team , although the latter applied the questionnaire one day before surgery. We compared the same patients over time and found a significant difference in the composite score, about mental health and role difficulty during the first month, while at three months these same variables are preserved, general vision showed an improvement, and eye pain, colour vision, and peripheral vision scores decreased; it may be possible that the changes reported in each item are higher the more time passes after surgery, but this requires an additional long-term study.
In epiretinal membranes, vitrectomy has significantly improved the components of quality of life, being the most important post-surgical improvement among the pathologies studied . It mainly impacts 10 subscales except for peripheral vision and general health (mean score 77.9). The results seem to be directly related to the presence and severity of preoperative metamorphopsia, but not visual acuity, contrast sensitivity, or central macular thickness . On the contrary, Ghazi reports that there is an improvement of the metamorphopsia-perception after surgery, and considers that the initial visual acuity correlates with the initial VFQ-25 score; however, in his study, VA does not improve considerably after surgery, and only remote activities, general vision, and the overall score had an improvement . Matsuoka  has reported that the greatest improvement-related items at 3 months after surgery are visual capacity, general vision, close activities, role difficulties, and the composite score, while at 12 months it is the improvement of the metamorphopsia-perception, general vision, close activities, distance activities, mental health, role difficulty, and the composite score. In this study, we found no difference in the pre-and post-surgical quality of life for this pathology, which was included in other causes of vitrectomy; the only item with a statistical difference was the eye pain that improved after surgery in the first month. However, further analysis is required to evaluate the quality of life and its correlation with the visual function test.
It is important to consider the quality of life as one of the variables within surgical success that are observed to increase, after surgery for retinal pathologies, which is more noticeable in older patients (43% in the evolution at one month), and in 47% of the cases three months after the intervention, which represents a 30% of change concerning the quality of life prior the vitrectomy, according to our findings. The relevance relies on the high prevalence of these diseases in our population and their poor control; to our knowledge, it is the first report of quality of life related to vision in patients undergoing vitrectomy in Mexico.
In conclusion, vitrectomy performed in patients with advanced diabetic retinopathy improves the quality-of-life score associated with vision and in each of the items from the first month after surgery, while for rhegmatogenous retinal detachment the relevant improvement is observed up to three months after surgery. Another prospective study with a long-term follow-up that considers vision and sensory tests is suggested, in addition to increasing the sample of patients.