Association of serum and vitreous homocysteine and uric acid concentrations with post-vitrectomy prognosis in patients with proliferative diabetic retinopathy

doi:10.4239/wjd.v17.i1.111808

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Jan 15, 2026 (publication date) through Jan 14, 2026

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. Jan 15, 2026; 17(1): 111808
Published online Jan 15, 2026. doi: 10.4239/wjd.v17.i1.111808

Association of serum and vitreous homocysteine and uric acid concentrations with post-vitrectomy prognosis in patients with proliferative diabetic retinopathy

Qi-Bo Ran, Chun-Yan Lei, Sheng Gao, Xiang-Gang Yang, Fei-Peng Jiang, Mei-Xia Zhang

Qi-Bo Ran, Chun-Yan Lei, Sheng Gao, Xiang-Gang Yang, Fei-Peng Jiang, Mei-Xia Zhang, Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China

Co-first authors: Qi-Bo Ran and Chun-Yan Lei.

Author contributions: Ran QB, Lei CY, and Zhang MX designed the research study; Gao S, Yang XG, and Jiang FP performed the research; Ran QB and Lei CY analyzed the data and wrote the manuscript. All authors have read and approved the final manuscript.

Supported by the Sichuan Provincial Science and Technology Support Project, No. 2024YFFK0303.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the West China Hospital of Sichuan University, No. 2020 (834).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Data will be made available on reasonable request from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Mei-Xia Zhang, MD, Chief Physician, Professor, Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. zhangmeixia@scu.edu.cn

Received: July 10, 2025
Revised: September 20, 2025
Accepted: December 2, 2025
Published online: January 15, 2026
Processing time: 188 Days and 17.6 Hours

Abstract

BACKGROUND

Proliferative diabetic retinopathy (PDR) is a major cause of vision loss, often requiring pars plana vitrectomy (PPV). Systemic and intraocular metabolic alterations, including dysregulation of homocysteine (Hcy) and uric acid (UA), may influence surgical outcomes. While prior studies suggest associations between these biomarkers and retinal pathology, the role of these biomarkers in postoperative prognosis remains unclear. This study hypothesized that elevated serum and vitreous Hcy and UA levels are associated with visual, structural, and microvascular changes following PPV in patients with PDR.

AIM

To evaluate the associations between serum and vitreous Hcy/UA concentrations with postoperative outcomes in patients with PDR following PPV.

METHODS

In this prospective observational study at a tertiary care center, 44 patients with PDR and 46 non-diabetic controls undergoing PPV between June 2021 and December 2022 were enrolled. Serum and vitreous Hcy and UA levels were measured. Best-corrected visual acuity, multimodal retinal imaging, and capillary density metrics were evaluated preoperatively and postoperatively. Correlation analyses assessed the relationships between biomarkers and clinical outcomes.

RESULTS

Patients with PDR showed significantly higher serum and vitreous Hcy and UA concentrations compared to those of controls. Serum Hcy and UA levels correlated with vitreous levels. In patients with PDR, elevated vitreous Hcy correlated with worse best-corrected visual acuity at 1 day and reduced peripapillary retinal nerve fiber layer thickness at 7 days and 90 days. It also correlated with foveal avascular zone enlargement at 90 days and inferior superficial capillary plexus (SCP) width density at 7 days. Vitreous UA had negative correlations at 30 days with nasal SCP length density and temporal/inner ring SCP width density.

CONCLUSION

Vitreous, but not serum, Hcy predicts post-PPV impairment, underscoring the prognostic value of the local ocular environment over systemic factors in PDR.

Keywords: Proliferative diabetic retinopathy; Homocysteine; Uric acid; Pars plana vitrectomy; Prognosis; Optical coherence tomography; Optical coherence tomography angiography; Diabetic retinopathy

Core Tip: This study demonstrates that vitreous homocysteine and uric acid are significantly elevated in patients with proliferative diabetic retinopathy, reflecting localized ocular pathology. Unlike their serum counterparts, elevated vitreous homocysteine specifically correlates with worse early visual acuity, progressive retinal nerve fiber layer thinning, and delayed microvascular impairment after pars plana vitrectomy, positioning it as a superior, compartment-specific predictor of multidimensional postoperative outcomes.