Posterior Vitreous Detachment Status as a Predictive Factor for Outcomes of Vitrectomy for Diabetic Vitreous Hemorrhage

Abstract

The purpose of this study was to evaluate the prognostic utility of the degree of vitreous attachment for predicting outcomes of vitrectomy for nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy.Methods: Medical records of patients who underwent primary vitrectomy for dense nonclearing vitreous hemorrhage secondary to proliferative diabetic retinopathy were examined retrospectively. Eyes were divided into four groups based on the intraoperatively assessed stage of posterior vitreous detachment (PVD), ranging from Stage 0/1 (complete or near-complete vitreoretinal adhesion) to Stage 4 (complete PVD).Results: Overall, 136 eyes (117 patients) were included. In comparison with eyes with a partial or complete PVD (Stages 2-4), eyes with no PVD (Stage 0/1) had a higher incidence of postoperative hypotony (8%, P = 0.03) and traction retinal detachment (27%, P = 0.002), an increased rate of repeat vitrectomy (49%, P = 0.04), and poorer best-corrected visual acuity at 6 months and 1 year postoperatively (P = 0.04 and P = 0.01, respectively). Presence of a complete PVD at baseline was independently associated with improved postoperative vision at 6 months (P = 0.04).Conclusion: More extensive vitreoretinal adhesion is associated with higher rates of reoperation and poorer visual outcomes after vitrectomy for dense nonclearing vitreous hemorrhage associated with proliferative diabetic retinopathy. Preoperative determination of PVD status using B-scan ultrasonography may be useful for predicting anatomical and functional outcomes after vitrectomy in these patients.

Analysis of Risk Factors for Revitrectomy in Eyes with Diabetic Vitreous Hemorrhage

“…Other potential risk factors associated with revitrectomy may overlap with those for PVH, including younger age, longer duration of diabetes, hypertension, renal disease, cardiovascular disease, use of antiplatelet or anticoagulation agents, neovascularization of the optic disc, and the absence of posterior vitreous detachment. 6,7,[37][38][39][40][41] However, no significant differences were observed in this study. Management of PVH includes observation, oral medication, laser supplementation, intravitreal injection of anti-VEGF drugs, and revitrectomy.…”

Preoperative co-application of bevacizumab and tissue plasminogen activator in vitrectomy for proliferative diabetic retinopathy

“…Missed remnants of the hyaloid or vitreous humor may increase the risk of reproliferation after surgery. Posterior vitreous detachment status is a predictive factor of vitrectomy outcomes in patients with diabetic vitreous hemorrhage (10) .…”

Treatment of Proliferative Diabetic Retinopathy in 2023

“…10,46 Conversely, a lack of posterior vitreous detachment may itself be a risk factor for greater surgical complications. 47 The risks associated with vitrectomy must be carefully considered before surgical intervention. Vitrectomy can lead to cataract progression, with 15% to 33% of phakic patients reported to have undergone cataract surgery within 2 years of PPV.…”

“…More recently, some clinicians have suggested a possible role of early vitrectomy in patients with attached hyaloid in order to preserve vision and prevent potentially devastating long-term PDR complications; additional proposed benefits include reduced treatment burden, improved long-term health care costs, and mitigated effect of possible lapses in care 10,46 . Conversely, a lack of posterior vitreous detachment may itself be a risk factor for greater surgical complications 47 …”