PONE-D-22-21450Ocular findings, surgery details and outcomes in proliferative diabetic retinopathy patients with chronic kidney diseasePLOS ONE

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PLOS ONE

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Additional Editor Comments:

I thought this paper was a very meaningful report from a clinical perspective for ophthalmologists.

I think the points made by the reviewers are very much on point.

I hope you accept the reviewers' points and that this paper will improve.

Thank you.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear authors,

This paper compares those having low renal function with those having normal renal function among proliferative diabetic retinopathy (PDR) patients having gone through pars-plana vitrectomy (PPV) by retrospective cohort design. Subjects of comparison are systemic and ocular findings by pre-operation screening, findings during operations and during follow-ups. This investigation found that PDR eyes of those having low renal function tend to show more severe retinal ischemic findings and occur intraoperative bleedings.

The results obtained emphasizes the importance of grasping the renal function of patients with diabetic retinopathy and will be educational for ophthalmologists taking part in PPV to PDR eyes.

I recommend that this paper be accepted after minor revision.

Major comments:

1. Have you accessed histories of DM control and compliance toward DMR treatments before operations by HbA1c, frequency of outpatient appointment, amount of leftover medicine, and so on?

Ischemic retinal changes may be related to CKD, but bad control of DM and patients’ non-cooperative behavior can be confounder both to the progression of DMR to PDR and deterioration of renal function. In addition to this, severely impaired renal function-- stage 4 and 5, for example-- also can affect patients’ commuting to your eye hospital because of hemodialysis schedules and poor physical condition. It may be difficult to quantify the patients’ compliance and cooperation, but I would appreciate it if you took them into consideration in some way.

Related question: Were the incomplete PRPs intentional by eye doctor or because of patients’ low attendance to your eye hospital?

2. How many patients took anti-platelet and / or anti-coagulant medicine and how long time before operation did you stopped it before operation? Table1 showed among patients with impaired renal function the number of combined stroke was larger than and the number of combined coronary heart disease was as large as the numbers among patients with normal renal function. Their medications could have affected intraoperative bleedings.

Minor comments:

Table1: presur”G”ery ocular findings and ocular medical history may be correct.

Sincerely,

Reviewer #2: Thank you for allowing me to review your paper.

It is a very good paper with a clinical point of view, and it would be very meaningful to publish it. However, at the moment it seems that some work is needed, mainly on statistical issues.

#1 First, please describe in the inclusion criteria whether dialysis patients are included among renal disorders.

#2 Next, if the study period is 3 months, change in visual acuity at 3 months.

It should be graphed and compared to before treatment. In addition, it is necessary to describe the presence or absence of anatomical reversion of the macula in the group in which OCT imaging was possible. The rate of onset of neovascular glaucoma and PVR, which are the most feared complications, would also be good indicators.

#3 In addition, multivariate analysis of final visual acuity and anatomical restoration of the macula, CKD grade, age, gender, presence or absence of PRP, presence or absence of IVR, visual acuity at first visit, etc. is required. This will ensure the success of this paper.

Let's add a discussion based on them.

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Reviewer #1: Yes: Hayato Tanaka

Reviewer #2: Yes: Mizuki　Tagami

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Ocular findings, surgery details and outcomes in proliferative diabetic retinopathy patients with chronic kidney disease

PONE-D-22-21450R1

Dear Dr. ZHAO,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Daisuke Nagasato

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I appreciated your response telling us the information about Diabetes Mellitus history investigation, affection of anti-platelet. These information helped our understanding of your research.

Reviewer #2: I think that it is well corrected and suitable for publication.　The reviewer feel that there is a strong relationship between renal function and intraoperative bleeding and postoperative ocular ischemic events.

Thank you for your good consideration.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: MIzuki Tagami

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