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Alice Behrens, Sami Uwaydat, Paige Johnson, Ahmed Sallam; Outpatient Air-Fluid Exchange for Persistent and Recurrent Vitreous Hemorrhage after Par Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4159. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Repeat pars plana vitrectomy (PPV) is commonly performed for persistent or recurrent postoperative vitreous cavity hemorrhage (POVCH). An alternative treatment to repeat PPV is outpatient air-fluid exchange (AFX). There is paucity of contemporary literature on the safety and efficacy of this procedure in the era of small incision vitrectomy surgery. In this study, we aimed to analyze the visual outcome and complications of office based AFX for management of POVCH.
This is retrospective study of all eyes undergoing office based AFX for POVCH at our institute from 01/2006-11/2016. Data collected included demographics, indication of original PPV, POVCH duration, time of AFXs or repeat PPV, complications of AFX, lens status at the time of AFX as well as visual acuity (VA) pre AFX and post AFX at 1 week, 1 month and 3 months. Facility cost for office- based AFX vs. PPV was also analyzed.
This study included 19 eyes of 18 patients. Nine patients were females (50%). Mean age (±SD) at the time of AFX was 55.63±8.23 years. Prior to AFX, 15 eyes (78.9%) were pseudophakic and 4 eyes (21.1%) were phakic. POVCH was due to diabetic retinopathy in 17 eyes (89.5%). The mean duration from onset of POVCH to AFX was 4.78 weeks (range: 0.71-39). The LogMAR VA of pre and post AFX was 2.37±0.20 [Snellen equivalence (SE) HM] and 1.19±0.95 (SE 20/310), respectively. After AFX, 3 eyes showed no improvement of VA but had co-existing pathology: radiation optic neuropathy (1 eye) and traction macular detachment (2 eyes). Excluding these 3 eyes, the mean post AFX improvement of LogMAR VA was 0.93±0.81 (SE 20/163); the mean improvement of LogMAR VA was 1.44 (p<0.0001). Complications of AFX included worsening of cataract in 3 phakic eyes (75%), hypotony (IOP<6mmHg) in 1 eye and recurrence of traction detachment in 1 eye. Three eyes (15.8%) required repeat PPV after AFX. Mean cost of office based AFX (CPT 67025) was $1461.14±58.22 and the cost of PPV (CPT code 67036/67040) was $3906.93±1076.52.
Office based AFX is associated with VA improvement in eyes with POVCH with an acceptable adverse-effect profile. Given its time and cost reduction advantages, office based AFX is worth considering as an initial approach for management of POVCH in eyes without co-existing retinal detachment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Figure 1. Correlation between post AFX BCVA LogMAR visual acuity vs. pre AFX acuity
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