Elsevier

Ophthalmology

Volume 114, Issue 4, April 2007, Pages 710-715
Ophthalmology

Original Article
Intravitreal Long-Acting Gas in the Prevention of Early Postoperative Vitreous Hemorrhage in Diabetic Vitrectomy

https://doi.org/10.1016/j.ophtha.2006.07.047Get rights and content

Objective

To evaluate the hemostatic effects of intravitreal infusion of 10% C3F8 in patients undergoing diabetic vitrectomy on the occurrence of early postoperative recurrent vitreous hemorrhage.

Design

Prospective, randomized, observational case series.

Participants

Sixty-one eyes (59 patients) that underwent primary pars plana vitrectomy for complications of proliferative diabetic retinopathy from September 2004 to April 2005, with postoperative retinal reattachment ≥ 3 months and follow-up > 6 months were enrolled.

Methods

Sixty-one cases were randomly divided into either group 1 (intravitreal 10% C3F8 infusion at the end of surgery) or group 2 (no intravitreal gas). Ultrasound biomicroscopy (UBM) examination of the 3 sclerotomy sites was performed at ≥ 2 months postoperatively. Demographic data, history, intraoperative findings, and management of recurrent vitreous hemorrhage were recorded.

Main Outcome Measures

Initial time to vitreous clearing (ITVC), percentage of prolonged ITVC (> 5 weeks), and early (≤ 4 weeks) versus late (> 4 weeks) manifest postoperative recurrent vitreous hemorrhage in groups 1 and 2 were compared to determine the effects of 10% C3F8 on prevention of early recurrent vitreous hemorrhage. Multiple logistic regression analyses were performed to examine risk factors related to early recurrent vitreous hemorrhage.

Results

Group 1 ITVC was 13.2±9.6 days, and group 2 ITVC was 11.3±11.1 days (P = 0.26). Prolonged ITVC (> 5 weeks) in each group was 1/31 (3.2%) and 2/30 (6.7%; P = 0.53). Early manifest recurrent vitreous hemorrhage rates in groups 1 and 2 were 0/31 (0%) and 5/30 (16.7%), respectively (P = 0.02). Early manifest recurrent hemorrhage plus prolonged ITVC in the 2 groups were 1/31 (3.2%) and 7/30 (23.3%), respectively (P = 0.02). The incidences of elevated intraocular pressure, iris neovascularization, and significant cataract formation among the 2 groups were too low to detect statistical significance. No evidence of fibrovascular ingrowth was found by UBM examination in either group. Multiple logistic regression analyses in non–gas-infused cases showed that an increased extent of membrane peeling raised the possibility of significant early vitreous rebleeding.

Conclusions

Intraocular tamponade with 10% C3F8 may be a useful adjunct to vitrectomy for proliferative diabetic retinopathy in the reduction of early postoperative recurrent vitreous hemorrhage.

Section snippets

Patients and Methods

From September 2004 to April 2005, consecutive patients undergoing primary pars plana vitrectomy for complications of proliferative diabetic retinopathy were recruited for the prospective study. Exclusion criteria were as follows: preoperative or postoperative anticoagulant therapy, blood diseases associated with abnormal coagulation, and silicone oil infusion or 15% C3F8 tamponade as a mandatory intraoperative procedure during retina reattachment. Informed consent was obtained from each

Results

In our study, group 1 consisted of 31 cases (30 patients) and group 2 of 30 cases (29 patients). After pars plana vitrectomy with or without gas infusion, all study patients had attached retina at the end of a minimum of a 6-month follow-up. Demographic data are summarized in Table 1. Surgical findings and additional surgical procedures are shown in Table 2. Patients’ characteristics were similar between groups 1 and 2; no statistically significant differences were noted between the groups. All

Discussion

Early recurrent vitreous hemorrhage after successful operation for diabetic retinopathy can occur in as high as 63% of cases.3 To prevent recurrent vitreous hemorrhage, ε-aminocaproic acid and tranexamic acid have been used systemically9; thrombin,15, 16 sodium hyaluronate,17, 18 and silicone oil19, 20 have been used intravitreally. Mechanical tamponade of the bleeding sites by air or nonexpansile SF6–air mixture also have been tried for hemorrhage prevention.11, 12 In the present study, 10% C3F

References (26)

  • A.E. Kreiger

    Wound complications in pars plana vitrectomy

    Retina

    (1993)
  • S. de Bustros et al.

    Effect of epsilon-aminocaproic acid on postvitrectomy hemorrhage

    Arch Ophthalmol

    (1985)
  • A.R. Ramezani et al.

    Effect of tranexamic acid on early postvitrectomy diabetic haemorrhage: a randomised clinical trial

    Br J Ophthalmol

    (2005)
  • Cited by (79)

    • Surgical management of diabetic tractional retinal detachments

      2019, Survey of Ophthalmology
      Citation Excerpt :

      Dikopf and colleagues69 reported similar rates of success with gas, silicone oil, and balanced salt solution (BSS) tamponades; similarly, Mikhail and colleagues218 experienced similar results with air, SF6, PFCL, and silicone oil tamponades. Long-acting gas tamponade decreases the rate of postoperative vitreous hemorrhage.89,364,373 In the absence of a retinal break, TRDs may be repaired without the use of endotamponade; subretinal fluid reabsorbs postoperatively.260,322

    View all citing articles on Scopus

    Manuscript no. 2005-1212.

    The authors have no financial interest in any materials or equipment used in the study.

    View full text