Ran QB, Lei CY, Gao S, Yang XG, Jiang FP, Zhang MX. Association of serum and vitreous homocysteine and uric acid concentrations with post-vitrectomy prognosis in patients with proliferative diabetic retinopathy. World J Diabetes 2026; 17(1): 111808 [PMID: 41608097 DOI: 10.4239/wjd.v17.i1.111808]
Corresponding Author of This Article
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
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Observational Study
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Ran QB, Lei CY, Gao S, Yang XG, Jiang FP, Zhang MX. Association of serum and vitreous homocysteine and uric acid concentrations with post-vitrectomy prognosis in patients with proliferative diabetic retinopathy. World J Diabetes 2026; 17(1): 111808 [PMID: 41608097 DOI: 10.4239/wjd.v17.i1.111808]
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, 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.
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 22.6 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.
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.
