Multiple factors in the prediction of risk of recurrent vitreous haemorrhage after sutureless vitrectomy for non-clearing vitreous haemorrhage in patients with diabetic retinopathy

Abstract

Background: We aimed to analyse multiple factors in the prediction of risk of postoperative recurrent vitreous haemorrhage (RVH) for non-clearing vitreous haemorrhage in patients with diabetic retinopathy (DR) who underwent sutureless vitrectomy with 23-(23G) or 25-gauge (25G) narrow-gauge systems. Methods: A retrospective consecutive case series design was used. DR patients who underwent sutureless vitrectomy for non-clearing vitreous haemorrhage between June 2017 and October 2019 were enrolled. All operations were performed at a tertiary hospital. Patient demographics and risk factors, including age, gender, duration of diabetes, preoperative fasting blood sugar levels (FBSL), systolic blood pressure (SBP), serum creatinine (Cr), urea, triamcinolone acetonide (TA), electrical coagulation, air-fluid exchange, pan-retinal photocoagulation status (PRP), anti-vascular endothelial growth factor drug (anti-VEGF), and other factors, were recorded. Patients were divided into two groups based on the timing of their postoperative RVH: immediate postoperative RVH (within 2 weeks after operation) and delayed postoperative RVH (beyond 2 weeks after operation). Results: Overall, 167 eyes (167patients) were enrolled. Seventy eyes were underwent 23G and 25G sutureless vitrectomy performed in 97 eyes, respectively. Postoperative RVH developed in 18 eyes (25.7%) in Group 23G and in 20 eyes (21.6%) in Group 25G (P = 0.540). Of these, 3 eyes (4.3%) had severed RVH in Group 23G compared with 5 eyes (5.2%) in Group 25G (P = 0.584). Delayed postoperative RVH occurred in 6 eyes (8.6%) in Group 23G and 8 eyes (8.2%) in Group 25G (P = 0.789). A binomial logistic regression analysis revealed that age, duration of diabetes, and Cr level were significantly associated with RVH in both Group 23G (P < 0.05) and Group 25G (P < 0.05). Conclusions: The incidence and severity of RVH were 25.7 and 4.3%, respectively, in Group 23G and 21.6 and 5.2%, respectively, in Group 25G. Thus, the 23G sutureless vitrectomy approach was as safe as the 25G sutureless vitrectomy approach for treating vitreous haemorrhage in patients with DR. A younger age, shorter duration of diabetes, and higher Cr levels were risk factors for postoperative RVH in sutureless vitrectomy.

Characteristics of proliferative diabetic retinopathy patients with postoperative vitreous hemorrhage after small-gauge vitrectomy

“…The PRP completion rate before vitrectomy were 17.1% and 15.5% in the 23-gauge and 25gauge groups, similar to our data. The rates of pre-vitrectomy IV-anti VEGF agents administration (14.3%, 34.0%) and endodiathermy (17.1%, 7.2%) were lower than ours[32].Schreur et al reported POVH occurrence as 14% (including both 20-gauge and 23-gauge vitrectomy, 217 patients)…”

“…[14] In the early era of 20-gauge vitrectomy, the in uence of continuing anticoagulation or antiplatelet medicine was suggested to be related to POVH [12,35,36]. In recent studies of small-gauge diabetic vitrectomy, most evidence supports that the continued use of anticoagulation or antiplatelet medication in the perivitrectomy period does not increase the chance of POVH [13,14,17,19,32,37]. Consistent with previous reports, we found that the occurrence of POVH was not signi cantly different between patients for whom anticoagulation or antiplatelet medications were continued (0/22) and patients for whom adjustments were made (11/198).…”

Prediction of Visual Outcomes After Diabetic Vitrectomy Using Clinical Factors From Common Data Warehouse

“… 21 – 23 Regarding diabetic vitrectomy, kidney function was also reported to be a factor affecting postoperative vision and recurrent hemorrhage. 20 , 24 However, this result requires further validation as estimated glomerular filtration rate, an important parameter for kidney function, did not correlate with visual outcome after diabetic vitrectomy. 25 Other factors identified as important predictors in the machine learning model, such as liver function and smoking, should similarly be studied in depth in subsequent studies.…”

“… 7 , 27 To minimize this disadvantage, we tried to include as many available relevant factors as possible. Additionally, both 23-gauge and 25-gauge systems for vitrectomy were included in the analysis, but the effect of this is likely negligible according to Ding et al 24 Difference in skill level of the surgeon and duration of surgery might have affected the visual outcome. Furthermore, medical and ophthalmologic diagnoses were assessed based on the disease code entered by clinicians and were not evaluated in detail.…”

Prospective Comparison of Surgery Outcome Between Preoperative and Intraoperative Intravitreal Injection of Ranibizumab for Vitrectomy in Proliferative Diabetic Retinopathy Patients

“…Postoperative VH, which had been reported to happen in 12-40% vitrectomized PDR patients, will hinder monitoring of disease course and require additional application of laser treatment, therefore delaying visual rehabilitation. The risk factors of postoperative VH include younger age, later detection of DM, poor diabetic and hypertension control, higher serum creatinine, broader area of active neovascularization, increased extent of membrane peeling, postoperative hypotony, postoperative residual neovascularization membrane, unrelieved vitreous retinal contraction and insufficient PRP [28,29]. PRP plays a protective role in disease progression and surgical difficulty of PDR [30].…”