Clinical Outcomes and Safety of 25-Gauge Pars Plana Vitrectomy in Vitreous Haemorrhage
DOI:
https://doi.org/10.51985/Keywords:
Vitreous Haemorrhage; Diabetic Retinopathy; Central Retinal Vein Occlusion (CRVO); Pars Plana VitrectomyAbstract
ABSTRACT
Objectives: This study evaluates the outcomes of 25-gauge pars plana vitrectomy (25G PPV) for dense vitreous haemorrhage (VH) of diverse etiology
Study Design and Settings: This is a prospective interventional study in which 25G PPV was performed for dense VH at a tertiary eye care centre. Eligible cases were selected from surgical retina clinic.
Methodology: All the investigations to determine the cause of VH were performed. Preoperative best corrected visual acuity(BCVA) was measured and then 25G PPV was performed. All the surgeries were done by the same surgeon. BCVA measurements were performed at postoperative day 1(Day1), one-month(1M), and two-month(2M) visits. Visual outcome was categorized based on underlying cause of VH
Results: The mean patient age was 51.4 years, with proliferative diabetic retinopathy (40.8%) being the most common aetiology, followed by central retinal vein occlusion (CRVO) and ocular trauma. Surgical intervention resulted in a significant and sustained improvement in visual acuity at all postoperative intervals (p < 0.001), with a mean gain of 0.530 logMAR at the two-month endpoint. The magnitude of improvement varied by aetiology; eyes with CRVO demonstrated the largest mean gain (0.784 logMAR), while trauma cases showed modest recovery (0.317 logMAR). The procedure demonstrated a favourable safety profile, with an overall complication rate of 14.3%, primarily consisting of recurrent VH (8.2%).
Conclusion: These findings confirm that 25-gauge PPV is a highly effective and safe intervention for restoring visual function in patients with dense VH, with aetiology serving as a key determinant of the final visual outcome
Keywords: Vitreous Haemorrhage; Diabetic Retinopathy; Central Retinal Vein Occlusion (CRVO); Pars Plana Vitrectomy
References
1. Spraul CW, Grossniklaus HE. Vitreous hemorrhage. Survey
of ophthalmology. 1997 Jul 1;42(1):3-9.. DOI: https://doi.org/
10.1016/s0039-6257(97)84041-6
2 . Kwon W, Freeman SA. Phagocytosis by the retinal pigment
epithelium: recognition, resolution, recycling. Frontiers in
immunology. 2020 Nov 13;11:604205. DOI: https://doi.org/
10.3389/fimmu.2020.604205
3. Campbell DG, Simmons RJ, Grant WM. Ghost cells as a
cause of glaucoma. Am J Ophthalmol. 1976;81(4):441–50.
DOI : https://doi.org/10.1016/0002-9394(76)90299-34. Machemer R. Pars plana vitrectomy. Removal of preretinal
membranes. Transactions. Section on Ophthalmology.
American Academy of Ophthalmology and Otolaryngology.
1976 May 1;81(3 Pt 1):420-5.
5. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge
instrument system for transconjunctival sutureless vitrectomy
surgery. Ophthalmology. 2002;109(10):1807–12. DOI:
https://doi.org/10.1016/s0161-6420(02)01179-x
6. Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal
procedures: an experimental and clinical study. Retina. 2016
Jan 1;36(1):137-47. DOI:https://doi.org/10.1097
/iae.0000000000000689
7. Singh A, Stewart JM. 25-Gauge vitrectomy. Ophthalmol Clin
North Am. 2004;17(2):201–6. DOI: https://doi.org/
10.1159/000360448
8. Hayreh SS, Podhajsky PA, Zimmerman MB. Natural history
of visual outcome in central retinal vein occlusion.
Ophthalmology. 2011;118(1):119–33DOI: https://doi.org/
10.1016/j.ophtha.2010.04.019
9. Sarrafizadeh R, Hassan TS, Ruby AJ, et al. Incidence of retinal
detachment and visual outcome in eyes presenting with
posterior vitreous detachment and dense fundus-obscuring
vitreous hemorrhage. Ophthalmology. 2001;108(12):2273–8
DOI : https://doi.org/10.1016/s0161-6420(01)00822-3
10. Johnston PB. Traumatic retinal detachment. Br J Ophthalmol.
1991;75(1):18–21. DOI: https://doi.org/10.1136/bjo.75.1.18
11. Chen SN, Lian IeB, Wei YJ. Clinical outcomes and
complications of 25-gauge transconjunctival sutureless
vitrectomy for proliferative diabetic retinopathy. Eye (Lond).
2017;31(12):1700–6. DOI : https://doi.org/10.1159/000328407
12. Shimizu H, Nakashima H, Uchida E, Kato M, Koga T, Hattori
T. Outcomes of 25-gauge vitrectomy for vitreous hemorrhage
associated with proliferative diabetic retinopathy. Clin
Ophthalmol. 2019;13:1543–51. DOI: https://doi.org/10.1007/
s00417-010-1506-7
13. Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27–gauge
instrument system for transconjunctival sutureless
microincision vitrectomy surgery. Ophthalmology.
2010;117(1):93-102. doi:10.1016/j.ophtha.2009.06.058
14. Sharma T, Fong A, Lai TY, Lee V, Das S, Lam D. Surgical
treatment for diabetic vitreoretinal diseases: a review. Clin
Exp Ophthalmol. 2016;44(4):340-54. doi:10.1111/ceo.12687
15. de Bustros S, Thompson JT, Michels RG, Rice TA. Vitrectomy
for progressive proliferative diabetic retinopathy. Arch
Ophthalmol. 1987;105(2):196-9. doi:10.1001/archopht. 1987.
01060020090033
16. Hayreh SS, Podhajsky PA, Zimmerman MB. Natural history
of visual outcome in central retinal vein occlusion.
Ophthalmology. 2011;118(1):119-33. doi:10.1016/j.ophtha.
2010.04.019
17. Sarrafizadeh R, Hassan TS, Ruby AJ, Williams GA, Garretson
BR, Capone Jr A, Trese MT, Margherio RR. Incidence of
retinal detachment and visual outcome in eyes presenting
with posterior vitreous separation and dense fundus-obscuring
vitreous hemorrhage. Ophthalmology. 2001;108(12):2273-8.
doi:10.1016/S0161-6420(01)00843-8
18. Johnston PB. Traumatic retinal detachment. Br J Ophthalmol.
1991;75(1):18-21. doi:10.1136/bjo.75.1.18
19. Shimizu H, Nakashima H, Uchida E, Kato M, Koga T, Hattori
T. Outcomes of 25-gauge vitrectomy for vitreous hemorrhage
associated with proliferative diabetic retinopathy. Clin
Ophthalmol. 2019;13:1543-1551. doi:10.2147/OPTH.S207840
20. Gupta OP, Weichel ED, Regillo CD, et al. Postoperative
complications associated with 25-gauge pars plana vitrectomy.
Ophthalmic Surg Lasers Imaging. 2007;38(4):270-275.
doi:10.3928/15428877-20070701-07
21. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for
neovascular age-related macular degeneration. N Engl J Med.
2006;355(14):1419-1431. doi:10.1056/NEJMoa054481
22. Johnston PB. Traumatic retinal detachment. Br J Ophthalmol.
1991;75(1):18-21. doi:10.1136/bjo.75.1.18
23. Gupta B, Wong R, Sivaprasad S, Williamson TH. Surgical
and visual outcome following 20-gauge vitrectomy in
proliferative diabetic retinopathy over a 10-year period:
evidence for change in practice. Eye (Lond). 2012;26(4):576-
582. doi:10.1038/eye.2011.348
24. Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience
using the transconjunctival sutureless vitrectomy system for
vitreoretinal surgery. Ophthalmology. 2002;109(10):1814-
1820. doi:10.1016/S0161-6420(02)01259-5
25. Shaikh Y, Elmariah H, Jones SM. Advanced vitreoretinal
surgery techniques for the treatment of complex vitreoretinal
diseases. Curr Opin Ophthalmol. 2018;29(3):212-217.
doi:10.1097/ICU.0000000000000464
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