Abstract
Abstract: :
Purpose: To review the outcomes of revision vitrectomy with panretinal laser photocoagulation in patients with post–vitrectomy diabetic vitreous hemorrhage (PVDVH) Methods: A retrospective, noncomparative, consecutive, single–surgeon review was performed of patients undergoing revision vitrectomy supplemented with indirect or endo–panretinal photocoagulation to treat PVDVH between 1998–2003. Visual acuities prior to the PVDVH, at the time of the index revision vitrectomy, and at the final follow–up visit were compared. Outcomes including recurrence of vitreous hemorrhage, progression of cataracts, retinal attachment, retinal neovascularization, the development of neovascular glaucoma, and need for further surgery were evaluated. Results: Twenty–four eyes of twenty–three patients were evaluated. Fifteen eyes (62.5%) were from patients with type II diabetes mellitus. With a median follow up of 12.7 months (range of 2 to 90 months), six of twenty–four eyes (25%) had recurrent vitreous hemorrhage. The median final visual acuity of 20/70 was improved from a median visual acuity of 20/200 prior to PVDVH (p=0.001) and CF/HM at time of revision vitrectomy (p<0.0001). Sixteen of the twenty–four patients (67%) were phakic while the remaining eight (33%) were pseudophakic prior to the index vitrectomy. Four phakic eyes showed mild progression of cataract, with two patients electing to undergo cataract extraction following index vitrectomy. Three of the 24 patients (12.5%) developed neovascular glaucoma requiring further surgical interventions such as tube shunt placement for intraocular pressure control. Conclusions: Panretinal photocoagulation, either with the endoprobe or indirect delivery system, is an effective alternative supplement to cryotherapy at the time of revision vitrectomy for PVDVH in both phakic and pseudophakic patients. Destruction of anterior retina can be performed with minimal trauma to the crystalline lens. Furthermore, avoidance of cryotherapy may allow preservation of the conjunctiva and permits concurrent or future surgery for patients with glaucoma.
Keywords: diabetic retinopathy • vitreoretinal surgery • vitreous