Abstract
Purpose: :
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.
Methods: :
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.
Results: :
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.
Conclusions: :
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.
Keywords: diabetic retinopathy • vitreoretinal surgery • proliferative vitreoretinopathy