Outpatient fluid-air exchange for severe postvitrectomy diabetic vitreous hemorrhage. Long-term results and complications

Abstract

An alternative treatment to repeat vitrectomy in postvitrectomy diabetic vitreous hemorrhage (PDVH) is outpatient fluid-air exchange, but the long-term visual results of this procedure are not known. Between January 1986 and April 1989, a pars plana air-pump technique was used to perform outpatient fluid-air exchange in 20 eyes of 17 patients (17 phakic eyes) within 8 weeks of onset of PDVH. A mean follow-up interval of 78 weeks was obtained. Preoperative vitreous hemorrhage was severe enough to obscure all fundus detail (17 eyes) or produce erythroclastic glaucoma (three eyes). Initial visual acuity was hand motions or light perception in 19 eyes and improved to a median visual acuity of 20/300 soon after resolution of the intraocular air bubble. Early complications included postoperative fibrin formation (one eye) and early postoperative intraocular pressure elevation (two eyes). Recurrent vitreous hemorrhage required repeated fluid-air exchanges in seven eyes. Long-term complications included worsening of posterior subcapsular cataract (10 of 17 phakic eyes, 59%), for which cataract extraction was required in five eyes (29%). Fluid-air exchange appeared to exacerbate cataract formation, justifying a period of observation for PDVH. However, it appeared to be a low-risk alternative to repeat vitrectomy, allowing rapid visual recovery from severe PDVH.