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Effie Rahman, Kinley Beck, Roberto Diaz-Rohena, Michael Singer; Practice Patterns Regarding Treatment of Vitreous Hemorrhage in Patients Following Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6557.
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To compare perceived vs. actual practice patterns regarding recurrent vitreous hemorrhage (VH) following pars plana vitrectomy (PPV)
250 retina specialists completed a 6-question survey regarding intravitreal bevacizumab (IVB) and surgical management for VH. For comparison, our institution performed a retrospective chart review to investigate outcomes of operated patients (pts) over an 18-month period. Measurement outcomes included demographics, IVB administration prior to PPV, whether air or gas was administered, recurrent VH, interval to VH clearance, and whether rebleeding was observed or treated with IVB or PRP. Chi-square and t-tests were used for statistical analysis.
Survey: 72.18% were in private practice. 63.1% administered IVB prior to surgery. 52.6% left the pt on fluid, 38.6% air-filled, and 8.84% gas-filled. 79.6% re-injected for recurrent VH (26.4% <30 days, 42.8 ≤45 days, 10.4% >45 days) while 1.2% performed PRP and 16.8% observed.Chart review: 42 pts underwent PPV for VH. 14/43 (33.3%) pts received IVB mean of 103 (range:16-776) days prior to surgery with 42.9% ≤30 days. 95.2% of pts received air. 71.4% rebled within 30 days, mean of 18.4 (range:1-185) (Figure 1). There was no difference between rebleeding rate over 6 months between pre- and untreated pts (71.43% for both; P=1.0). 23.3% of rebleeds were treated with IVB and 3.3% with PRP. 7.14% of pre-treated pts were treated with IVB vs 30% of untreated pts (Figure 2). Compared to survey responders, our teaching institute administers 2x less pre-op IVB (P= 0.0003) and maintains more patients on air (P<0.0001). They also administer 3x as much IVB for recurrent VH (P<0.0001). Reasons for decreased pre-op IVB include: presence of subhyaloid hemorrhage in 35.7%, monocular status in 3.57% necessitating expedited surgery, fibrotic membranes/possible TRD in 28.6% and posterior vitreous detachment/retinal tear in 7.12%. Pretreated pts required less IVB retreatment after surgery (P= 0.9016).
There is a difference between how VH is actually managed between our teaching institution vs. survey responders with their increased use of IVB both pre and post op. Those pre-treated with IVB had a statistically significant decreased rate of recurrent VH at POD1 but not overall rate of recurrent VH or interval of VH clearance.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Comparison between Survey Responders and Institutional Findings
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