Reasons for and management of postvitrectomy vitreous hemorrhage in proliferative diabetic retinopathy.

摘要

OBJECTIVE: To analyze the reasons for postvitrectomy vitreous hemorrhage in proliferative diabetic retinopathy (PDR), and to evaluate the effects of retreatment. Design: Retrospective, nonrandomized, observational case series. METHODS: Three hundred and fifteen eyes of 302 consecutive patients underwent primary standard three-port vitrectomy with 20-gauge instruments for complications of PDR from 2000 to 2006. One hundred and forty-two patients were male, and 160 were female. The age ranged from 38 to 72 years with a mean of 56 years. There were 32 eyes which developed postvitrectomy vitreous hemorrhage during follow-up. The mean follow-up was 12 months with a range from 3 to 48 months. RESULTS: Of 315 eyes with PDR and receiving pars plana vitrectomy, 32 eyes had postvitrectomy vitreous hemorrhage. The onset of recurrent vitreous hemorrhage ranged from 1 to 210 days with an average of 51 days. The reasons for postvitrectomy vitreous hemorrhage in PDR mainly included fibrovascular ingrowth at sclerotomy sites (9 eyes), residual or recurrent neovascular membrane on the optic nerve (6 eyes), insufficient retinal photocoagulation (7 eyes), residual and recurrent epiretinal proliferative membrane (3 eyes), retinal vein occlusion (2 eyes), postoperative low intraocular pressure (2 eyes), and ocular trauma (3 eyes). The visual acuity increased in 31 eyes (96.88%), and decreased in 1 eye (3.12%) after retreatment. The postoperative complications following the treatment of recurrent vitreous hemorrhage mainly included posterior synechia of the iris (3 eyes), nucleus sclerosis (18 eyes), and delayed healing of corneal epithelium (3 eyes). CONCLUSION: Vitrectomy is a safe and effective method for treating PDR. Appropriate and complete analysis of postvitrectomy vitreous hemorrhage can significantly improve the primary treatment effects for PDR.