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M. S. Pezda, J. Apple, A. Tewari; Rate of Recurrent Vitreous Hemorrhage after 23-Gauge Vitrectomy for Non-Clearing Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4212.
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To evaluate the visual outcomes and determine the rate of recurrence of vitreous hemorrhage in patients that have undergone primary 23-gauge pars plana vitrectomy for non-clearing vitreous hemorrhage due to proliferative diabetic retinopathy.
A retrospective review was conducted of 27 consecutive 23-gauge vitrectomy cases that were done for non-clearing vitreous hemorrhage in patients with proliferative diabetic retinopathy. All surgeries involved triamcinolone-assisted peeling of the internal limiting membrane and panretinal photocoagulation with an endolaser probe. Patients with less than one month follow-up were excluded. Data that was reviewed included pre-operative visual acuity and best corrected visual acuity at most recent follow-up. In addition, recurrent vitreous hemorrhage that occurred in the post-operative period was noted, as well as any interventions, including repeat vitrectomy. Status of the intraocular lens was also recorded. Comparison between pre-operative and final visual acuity was performed using the Wilcoxon signed rank test.
Of the 27 vitrectomies performed, there were 22 males and 5 females and the mean age was 57 years. Mean follow-up was 6.5 months. There were 22 phakic patients and 5 pseudophakic patients. Mean pre-operative visual acuity was 20/800 (20/50 to LP) and mean final visual acuity was 20/250 (20/25 to HM) (p=0.044). Twenty one patients (78%) remained clear of vitreous hemorrhage in the postoperative period. Six patients (22%) had a recurrence of vitreous hemorrhage, with 4 patients (15%) requiring repeat vitrectomy. Mean interval between surgeries was 3 months (range 2 to 5 months). All 4 patients remained clear of hemorrhage after repeat vitrectomy.
Twenty-three gauge pars plana vitrectomy is an effective surgical technique for diabetic non-clearing vitreous hemorrhage. Although there have been concerns with small gauge vitrectomy and the ability to place adequate peripheral laser treatment, our results compared favorably with published literature on 20-gauge surgery.
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