Entry Site Neovascularization and Vitreous Cavity Hemorrhage after Diabetic Vitrectomy

Cryotherapy of sclerotomy sites for prevention of late post-vitrectomy diabetic hemorrhage: a randomized clinical trial

“…Yeh et al noticed a decreased chance of fibrovascular ingrowth in patients receiving both cryotherapy of the anterior peripheral retina and the sclerotomy sites [25]. In two other studies, an association of UBM-detected fibrovascular ingrowth with recurrent VH following diabetic vitrectomy was found [8,19]. In our trial, we did not find any relation between cryotherapy and morphologic patterns of the sclerotomy sites, or between these patterns and the occurrence of late VH.…”

“…Recurrent VH is often the result of fibrovascular ingrowth reproliferation of neovascular tissue [1, 8-10, 14, 15, 21, 23]. Fibrovascular ingrowths have been shown by high-resolution ultrasound biomicroscopy (UBM) of the sclerotomy sites in patients with recurrent VH [2,6,16,19]. Recent attention has been given to specific means of reducing neovascularization and fibrous ingrowth at the sclerotomy sites, including cryotherapy of the sclerotomy sites and anterior retina.…”

Entry site treatment to prevent late recurrent postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy

“…Furthermore, the follow-up period is important. POVCH can occur years after the original surgery although most recurrent POVCH occurs within the first 6 months 17 18 21. This study was principally interested in recording the incidence of late recurrent POVCH, which we defined as any observed POVCH occurring after 3 weeks postoperatively.…”

“…Sclerostomies were made as follows: 20 g—tunnelled incisions were used as previously described;18 23 and 25 g—acutely oblique entry into the sclera was made with the trochar using the Accurus one step entry system and continued until the sclerostomy cannula abutted the sclera. The trochar was then moved to 30° to the globe and final entry made.…”

“…The presence of ESNV is difficult to observe clinically because of the very anterior location but can be confirmed at the time of revision surgery with deep scleral indentation or endoscopic techniques. It can also be localised with anterior segment high-resolution ultrasonography of the inner sclerostomy sites 13 14 17 18…”