Abstract
Purpose :
The 27-gauge (27g) sutureless transconjunctival vitrectomy system is increasingly being utilized in more complex operations, however there exists a knowledge gap on the postsurgical complications with this system, of which vitreous hemorrhage (VH) is one of the most common. We conducted a retrospective, observational clinical study to evaluate the incidence, risk factors, and outcomes of VH after 27g PPV for DM-TRD.
Methods :
This is a single-center, retrospective interventional case study of patients who underwent 27g PPV by a single surgeon for DM-TRD. Subjects' medical and ocular risk factors, intraoperative variables, and postoperative visual acuity (VA) information were collected through chart review. These variables were analyzed to determine their relationships with postoperative vitreous hemorrhage (PoVH), spontaneous clearing postoperative VH (SC), and reoperation for non-clearing postoperative VH (ReOp).
Results :
91 eyes from 72 patients were analyzed. 43 eyes (47.3%) developed or redeveloped VH within 12 months of 27g PPV treatment of DM-TRD. Of these, 25 cases (58.1%) were SC and of the remaining 18 eyes that were non-SC, 14 (77.8%) underwent reoperation for VH clearance. On statistical analysis, better preoperative VA was associated with less PoVH (p=0.04) and ReOp (p=0.03). Intraoperatively, retinotomy creation (Ret) was associated with greater ReOp (p=005) and filling the eye with filtered air was significantly associated with greater SC (p=0.04) compared to filling with silicone oil or gas. In terms of VA, having PoVH significantly decreased VA at all follow up visits up to one year after 27g PPV compared to not having PoVH. However, there was no significant difference in VA between SC eyes and non-SC eyes or between SC eyes and ReOp eyes at any point in follow up.
Conclusions :
The incidence rate of VH after 27g PPV was found to be comparable to that of other PPV gauges. A majority of PoVH cases were SC with only 18 cases of 91 (19.8%) requiring ReOp. Preoperative VA, intraoperative Ret creation, and eye fill represent potential variables to examine for predictors of PoVH, SC, and ReOp. Postoperative VA only differed significantly between cases of PoVH and no PoVH and not between SC vs. non-SC or SC vs. ReOp cases. Additional analysis is required to further elucidate the risk factors and outcomes for postoperative VH after 27g PPV treatment of DM-TRD.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.