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Jessica Alana Scott, William Bloom, Liyung T. Chou, Matthew Ohr; Diabetic Vitrectomy: Evaluating the Impact of Lens Status in Recurrent Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6543.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic retinopathy is a leading cause of vision loss in developed countries. Post-vitrectomy vitreous hemorrhage is a major complication that often leads to visual impairment and need for reoperation. The management of diabetic vitrectomy in phakic patients has been debated in the retina community throughout the years. It is postulated that the presence of the crystalline lens anatomically limits access to the anterior vitreous and epiretinal proliferation during vitrectomy in advanced cases of proliferative diabetic vitrectomy. Therefore, vitreous hemorrhages may be more likely to persist or recur in these phakic patients. The purpose of this retrospective study was to evaluate the impact of the lens status, whether phakic or pseudophakic, in the rate of recurrence of non-clearing vitreous hemorrhage (NCVH) in diabetic patients undergoing pars plana vitrectomy.
This was a retrospective chart review of diabetic retinopathy patients who underwent primary pars plana vitrectomy by one surgeon for complications relating to diabetic retinopathy between June 1, 2015 and February 1, 2018. The institutional review boards of The Ohio State University (Columbus, OH) approved this study.
During the study period, 105 eyes underwent primary pars plana vitrectomy for diabetic disease. Seventy eyes were phakic at the time of surgery. We found that 17% of phakic eyes required reoperation for recurrent vitreous hemorrhage in comparison to 5.7% in pseudophakic eyes (P < 0.0892). Of the phakic patient requiring reoperation for NCVH, the initial indication for surgery was traction retinal detachment + vitreous hemorrhage in 92% of cases. Overall, 90% of all eyes received intraoperative Bevacizumab injection at the end of each case.
The findings of this study suggest that there may be a greater need for reoperation for NCVH in the phakic diabetic patients. Although significance is limited by the sample size, this is promising data to aid vitreoretinal surgeons in the decision-making process of managing the crystalline lens in diabetic vitrectomy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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