Peripheral retinal cryotherapy for postvitrectomy diabetic vitreous hemorrhage in phakic eyes. 1998

K A Neely, and M W Scroggs, and B W McCuen
Department of Ophthalmology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA.

OBJECTIVE To review the anatomic and visual outcomes of a consecutive series of phakic patients with postoperative diabetic vitreous hemorrhage (PDVH) who underwent revision vitrectomy with peripheral retinal cryotherapy. METHODS We performed a retrospective chart review of consecutive phakic patients who underwent revision vitrectomy for PDVH who also received peripheral retinal cryotherapy. Final corrected visual acuities after revision vitrectomy with peripheral retinal cryotherapy were compared to corrected visual acuities before and at the time of PDVH. Anatomic outcomes such as retinal attachment, vitreous hemorrhage, iris neovascularization, lens opacity, and anterior hyaloidal neovascularization were considered. RESULTS Nineteen (86%) of 22 eyes (21 patients) that underwent revision of vitrectomy and transscleral peripheral retinal cryotherapy for PDVH also received supplementary endolaser photocoagulation in the posterior pole. In 16 eyes (73%), no further vitreous hemorrhaging occurred after this procedure. In six eyes (27%), vitreous hemorrhage recurred after revision of vitrectomy and peripheral retinal cryotherapy but cleared spontaneously in three of these eyes. Of the three eyes with nonclearing recurrent vitreous hemorrhage after revision of vitrectomy and peripheral retinal cryotherapy, the cause for the vitreous hemorrhage was known for two: severe, progressive anterior hyaloidal neovascularization. With a mean follow-up +/- SD of 6.8 +/- 5.1 months (range, 0.5 to 19.5 months), final corrected visual acuity after revision of vitrectomy and peripheral retinal cryotherapy for PDVH improved over preoperative visual acuity (at which time vitreous hemorrhage was present) in 18 eyes (82%) because of removal of vitreous hemorrhage from the visual axis. However, final visual acuity reached or exceeded pre-PDVH visual acuity in only five of the 15 eyes for which pre-PDVH visual acuity was known. CONCLUSIONS For phakic eyes with nonclearing PDVH, peripheral retinal cryotherapy (often augmented, when possible, by additional posterior pole endolaser photocoagulation) may be used to supplement previous retinal ablative therapy during revision of vitrectomy. This procedure leads to anatomic stabilization and visual improvement in the majority of eyes. Transscleral peripheral retinal cryotherapy is often feasible in situations (such as media opacity) that preclude use of peripheral retinal endolaser or indirect laser photocoagulation.

UI MeSH Term Description Entries
D007908 Lens, Crystalline A transparent, biconvex structure of the EYE, enclosed in a capsule and situated behind the IRIS and in front of the vitreous humor (VITREOUS BODY). It is slightly overlapped at its margin by the ciliary processes. Adaptation by the CILIARY BODY is crucial for OCULAR ACCOMMODATION. Eye Lens,Lens, Eye,Crystalline Lens
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D012008 Recurrence The return of a sign, symptom, or disease after a remission. Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D012160 Retina The ten-layered nervous tissue membrane of the eye. It is continuous with the OPTIC NERVE and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the CHOROID and the inner surface with the VITREOUS BODY. The outer-most layer is pigmented, whereas the inner nine layers are transparent. Ora Serrata
D002386 Cataract Partial or complete opacity on or in the lens or capsule of one or both eyes, impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). (Dorland, 27th ed) Cataract, Membranous,Lens Opacities,Pseudoaphakia,Cataracts,Cataracts, Membranous,Lens Opacity,Membranous Cataract,Membranous Cataracts,Opacities, Lens,Opacity, Lens,Pseudoaphakias
D002387 Cataract Extraction The removal of a cataractous CRYSTALLINE LENS from the eye. Enzymatic Zonulolysis,Phakectomy,Cataract Extractions,Enzymatic Zonulolyses,Extraction, Cataract,Extractions, Cataract,Phakectomies,Zonulolyses, Enzymatic,Zonulolysis, Enzymatic
D003930 Diabetic Retinopathy Disease of the RETINA as a complication of DIABETES MELLITUS. It is characterized by the progressive microvascular complications, such as ANEURYSM, interretinal EDEMA, and intraocular PATHOLOGIC NEOVASCULARIZATION. Diabetic Retinopathies,Retinopathies, Diabetic,Retinopathy, Diabetic

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