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Matthew Armstrong Powers, Ryan A Shields, Cassie Ann Ludwig, Darius M. Moshfeghi; Outcomes of Vitrectomy in Von Hippel-Lindau Disease. Invest. Ophthalmol. Vis. Sci. 2018;59(9):886.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of the current study is to examine the characteristics and clinical outcomes of von Hippel Lindau (VHL) patients having undergone pars plana vitrectomy, and to compare these outcomes to age matched controls.
A retrospective cohort study was conducted. At a single institution, patients with VHL who underwent pars plana vitrectomy (PPV) between 1/1/2014 and 1/1/2017 were identified using ICD-9, ICD-10 and CPT codes. Aged matched controls were identified. Demographic variables, preoperative diagnoses, procedures performed, vitrectomy gauge, postoperative vision, intraocular pressure and complications were recorded. The VHL cohort was compared to the control cohort using statistical analysis.
Twenty three PPV's were performed during the specified time period. The mean age was 34.74 years old. The most common surgical diagnosis in VHL patients was recurrent retinal detacment (n=15), PVR (n=13), and tractional retinal detachment (n=5). Aside from PPV, the most common procedures performed in VHL patients was endolaser (n=17), membrane peeling (n=15), silicone oil tamponade (n=10), and scleral buckling (n=3). Mean vision (in logMAR) on postoperative day 1, week 1 and month 1 was 2.27, 1.94, and 1.38, respectively. Mean intraocular pressure (IOP) for these visits was 16, 15 and 12.14, respectively. Postoperative day one visits were generally uncomplicated, with elevated IOP occuring in one patient. The most common complications occuring at postoperative week one were elevated IOP (n=3), vitreous hemorrhage (n=1) and hyphema (n=1). The most common complications at postoperative month one were cystoid macular edema (n=4), recurrent retinal detachment (n=4), and subretinal fluid (n=2). When compared to normal controls, VHL patients were more likely to require endolaser (p=0.0065), require postoperative anti-VEGF therapy (p=0.0005), experience any complication at postoperative month one (p=0.0022) and experience low IOP at postoperative month 1 (p=0.0047). No significant difference was detected in visual acuity between the groups postoperatively.
Patients with VHL do generally well in the early postoperative period following PPV, although complications tend to occur at month one, and include recurrent detachment, cystoid macular edema, and subretinal fluid. VHL patients are more likely to require endolaser and anti-VEGF therapy postoperatively.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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