Evolutionary Profile of Severe Forms of Diabetic Retinopathy Treated at a Referral Center in Madagascar: A Report on 100 Cases

Abstract: Objectives: To evaluate the functional and anatomical outcomes of severe forms of diabetic retinopathy (DR) after treatment, and to identify factors associated with improved visual acuity (VA). Patients and Methods: This was an observational analytical study conducted in the Ophthalmology Department of Joseph Ravoahangy Andrianavalona University Hospital (Antananarivo), including diabetic patients with severe forms of DR, treated and followed between December 2021 and June 2024. Demographic, clinical, paraclinical, therapeutic, and follow-up data were collected. Results: Out of 135 records, 100 patients were included (mean age 58.9±8.5 years, 58% male). Proliferative complicated DR predominated (67%), and maculopathy was present in 45% of cases. At six months, VA had improved in 50% of patients, and regression of lesions was observed in 96%. Factors significantly associated with visual improvement were: absence of cataract (RR = 1.9), absence of maculopathy (RR = 1.7), completion of at least 3,000 laser impacts (RR = 1.5), vitrectomy (RR = 1.6), treatment with bevacizumab (RR = 1.5), and combined therapy (anti-VEGF plus laser plus vitrectomy) (RR = 1.6). Well-controlled hypertension under monotherapy was also associated with a better functional prognosis (RR = 1.6). Conclusion: Even at an advanced stage, intensive treatment can achieve functional improvement and/or stabilization in patients with severe DR.