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2017, Number 1

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Rev Med MD 2017; 8.9 (1)

Rebleeding on vitreous cavity after vitrectomy due to persistent hemorrhage secondary to diabetic retinopathy

Zaldívar-Orta EL, López CR, Arévalo-Simental DE, Cisneros-Gómez S, Roig-Melo EA

Language: Spanish
References: 39
Page: 37-45
PDF size: 648.91 Kb.


ABSTRACT

Introduction. Diabetic retinopathy and its complications are the leading cause of blindness in people between 25-74 years of age, accounting for 12% of global blindness. Along with diabetic macular edema, proliferative diabetic retinopathy is one of the complications that cause visual impairment. The 3-port pars-plana vitrectomy has been for decades the surgical standard in handling many of the complications of persistent diabetic retinopathy.The aim of the study was to report the frequency of vitreous cavity rebleeding in patients undergoing vitrectomy via 25- gauge pars plana for persistent vitreous hemorrhage secondary to proliferative diabetic retinopathy.
Material and Methods. A review of the patient files who underwent a 25-gauge Pars Plan Vitrectomy owing to a persistent vitreous hemorrhage secondary to diabetic retinopathy in the retinal service at the Fray Antonio Alcalde Civil Hospital of Guadalajara during the period of October 2012 to December 2015. The possible risk factors associated to the presence of rebleeding were analyzed.
Results. We included 145 eyes belonging to 145 patients. During the follow-up period of 9.45 months (1-32), 42 patients (29%) presented rebleeding in the vitreous cavity. 16% (23%) were classified as early, and 13% as late (19). Amongst the patients with rebleeding, 28.5% was resolved spontaneously. 31% were applied intravitreous antiangiogenics, and 38% required surgical intervention (11% of the total). Factors which are associated to rebleeding were younger age (60 vs. 55 years old, p=0.008) faquia (11.6% vs 40.4%, p=0.0001). It was found a higher HbA1c on patients with rebleeding (7.7% vs 8.68%, p=0.05). A higher proportion of patients with rebleeding had a history of previous laser photocoagulation (41.7% vs 57.1%, p=0.092). None of these two differences showed as statistically significance. The visual acuity improved in both groups (2.16 logMAR pre-surgery vs 0.86 logMAR final, p‹0.05).
Conclusions. Rebleeding of the vitreous cavity is a frequent complication, occurring in 29% of the diabetic patients after a 25-gauge primary vitrectomy owing to persistent vitreous hemorrhage, and was associated to younger age and faquia. The majority of the rebleeding cases (62%) were resolved with observation or an intervention (e.g intravitreous antiangiogenic, fluid-air exchange). The rest was resolved with a second surgical intervention. The average visual acuity significantly improved in both rebleeding and patients with no rebleeding. These findings are consistent with what was previously published, despite the fact that is considered that Mexican patients have more severe retinopathies and a higher rate of post-operatory complications.


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