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To compare the axial length (AL) and assess its influence on VTDR across different ages.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective cohort study. Medical chart review was performed in 736 consecutive patients with VTDR. The patients were divided into young (\u2264\u200945\u00a0years) and elderly group (&gt;\u200945\u00a0years) based on their age at the diagnosis of VTDR. After at least one year of standardized treatments, all eligible patients were followed up. The main outcome measures included the presence of tractional retinal detachment (TRD) involving foveal, final best-corrected visual acuity (BCVA), the development of neovascular glaucoma (NVG), and recurrent vitreous hemorrhage (VH) post-vitrectomy. ALs were compared between two age groups. The impact of AL on clinical outcomes was determined by logistic analyses after controlling for systemic parameters.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The study included 144 patients\u2009\u2264\u200945\u00a0years and 592 patients\u2009&gt;\u200945\u00a0years. Young patients had significantly longer AL than elderly participants (23.9\u00a0mm vs 23.0\u00a0mm, p\u2009&lt;\u20090.001). Over a median follow-up of 25.9\u00a0months, a larger proportion of young patients developed TRD (34.7% vs 16.2%, p\u2009&lt;\u20090.001) and recurrent VH (18.6% vs 10.3%, p\u2009=\u20090.040) than elderly patients. In elderly group, longer AL is an independent protective factor in preventing TRD (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.4\u20130.7; P\u2009&lt;\u20090.001). However, this beneficial effect was not observed in young patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Young patients with VTDR exhibited significantly longer AL but more aggressive clinical signs with compromised prognosis. In elderly group, a longer AL independently reduced the risk of TRD, while this protective effect did not exist for young patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40942-024-00593-x","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T08:02:08Z","timestamp":1728547328000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Is longer axial length protective of vision-threatening diabetic retinopathy across different ages? 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This study was approved by the institutional review board, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine  (identifier, 2022KY024). Informed consent was obtained from each patient. All the patients were fully informed and participated in this study voluntarily without additional compensation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors approved this publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"74"}}