Visual Outcomes and Complications After Multiple Vitrectomies for Diabetic Vitreous Hemorrhage

Diabetic vitreous hemorrhage secondary to proliferative diabetic retinopathy is a cause of severe vision loss in diabetic patients. Laser photocoagulation remains the primary treatment when the view allows. Intravitreous anti-VEGF injections do not appear to have a role as primary treatment but may have an invaluable role as adjuvant to surgery. Pars plana vitrectomy with endolaser panretinal photocoagulation remains the procedure of choice for non-clearing vitreous hemorrhage. The vast majority of patients with vision of 5/200 or less due to diabetic vitreous hemorrhage do not clear spontaneously even after 1 year. With improvements in surgical techniques leading to better outcomes, fewer complications, less discomfort and a faster recovery time it is reasonable to operate on such patients sooner than the 3–4 months that had been generally accepted in the past, if there has been no significant spontaneous improvement.

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“…40, 52, 55 It is uncommon for patients to require more than a single repeat PPV due to recurrent VH. 40, 68 …”

Section: Complications After Vitrectomy For Vhmentioning

confidence: 99%

Current Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy

Annan

Carvounis

2014

International Ophthalmology Clinics

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“…In patients with diabetic vitreous hemorrhage, the rate of recurrent hemorrhage varies between 12% and 63% 20,22–26. In the present study, 23 eyes (27.1%) developed mild hemorrhage whereas one had moderate hemorrhage requiring a second operation.…”

Section: Discussionmentioning

confidence: 39%

Surgical results of combined pars plana vitrectomy and phacoemulsification for vitreous hemorrhage in PDR

Canan¹,

Altan-Yaycıoğlu²

2013

OPTH

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BackgroundThe purpose of this study was to evaluate the effectiveness, safety, and incidence of complications after combined clear corneal phacoemulsification with intraocular lens implantation and pars plana vitrectomy in eyes with proliferative diabetic retinopathy coexistent with significant cataract.MethodsEighty-five eyes of 85 patients with proliferative diabetic retinopathy underwent primary standard three-port vitrectomy with 20-gauge instruments and phacoemulsification with intraocular lens implantation for vitreous hemorrhage from 2008 to 2011. The main outcome measures were visual outcomes and surgical complications.ResultsForty patients were male and 45 were female. Their age ranged from 40 to 77 years with a mean of 59.6 years. The mean follow-up was 13 months, with a range of 6–48 months. The preoperative logMAR visual acuity changed from 2.62 ± 0.6 to 0.8 ± 0.7 postoperatively. Postoperatively, visual acuity improved in 79 eyes (92.9%), and did not change in six eyes (7.1%). Intraoperative complications were transient corneal edema (five eyes) and posterior capsular rupture (one eye). Postoperative complications consisted of transient intraocular pressure elevation (25 eyes), corneal epithelial defects (six eyes), anterior chamber reaction (four eyes), hyphema (two eyes), posterior synechiae (four eyes), vitreous hemorrhage (23 eyes), retinal tears (five eyes), retinal detachment (one eye), and neovascular glaucoma (one eye).ConclusionOur study suggests that the combined operation of pars plana vitrectomy, phacoemulsification, and intraocular lens implantation is safe and effective for patients with proliferative diabetic retinopathy. We believe that the visual outcome and complications depended primarily on underlying posterior segment pathology and were not related to the combined procedure technique.

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“…Only one case series was found which looked solely at vitreous hemorrhage outcomes in a similar fashion to our case series, and it showed a wide range of results, from better than 20/50 to worse than 20/400. 6 The variability in visual outcomes is likely due to the presence of co-existing diabetic eye disease, such as neovascularization leading to a retinal detachment. Table 5 includes a breakdown of visual outcomes from the case series (Cooper et al) of patients who underwent vitrectomy for non-clearing vitreous hemorrhage.…”

Section: Vitreous Hemorrhagementioning

confidence: 99%

Visual and anatomic outcomes of vitreoretinal surgery: results at the Boston VA and a review of the literature

Hanley-Williams

Subramanian

Feinberg

2009

DJO

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Visual Outcomes and Complications After Multiple Vitrectomies for Diabetic Vitreous Hemorrhage

Abstract: Multiple vitrectomies for recurrent diabetic vitreous hemorrhage can have a favorable anatomic outcome while maintaining ambulatory vision.

Cited by 15 publications

References 6 publications

Current Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy

Current Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy

Surgical results of combined pars plana vitrectomy and phacoemulsification for vitreous hemorrhage in PDR

Visual and anatomic outcomes of vitreoretinal surgery: results at the Boston VA and a review of the literature

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