Entry site neovascularization and vitreous cavity hemorrhage after diabetic vitrectomy : the predictive value of inner sclerostomy site ultrasonography

Steel, David, Habib, Maged, Park, S., Hildreth, Anthony and Owen, R. I. (2008) Entry site neovascularization and vitreous cavity hemorrhage after diabetic vitrectomy : the predictive value of inner sclerostomy site ultrasonography. Ophthalmology, 115 (3). pp. 525-532. ISSN 0161-6420

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Abstract

Objective To assess the incidence of neovascularization of the inner sclerostomy wound and occurrence of postoperative vitreous cavity hemorrhage (POVCH) after vitrectomy for proliferative diabetic retinopathy (PDR). Design Consecutive prospective longitudinal clinical study. Participants Seventy-three eyes (58 patients) undergoing primary vitrectomy for PDR. Methods Twenty-megahertz (MHz) high-resolution anterior segment ultrasonography was performed on all sclerostomy sites 2 months postoperatively and repeated at the time of any POVCH. The appearance of the inner sclerostomy wound was divided into 4 classes (normal, spheroidal, tent, and trapezoidal, representing entry site neovascularization). The occurrence, degree, and duration of POVCH and need for revision surgery with vitreous cavity washout (VCW) were recorded. Postoperative vitreous cavity hemorrhage was divided into 3 groups—namely, mild, moderate, and major. Main Outcome Measures Inner sclerostomy wound appearance on ultrasonography, degree and timing of POVCH, and need for VCW. Results There were 15 eyes in total with POVCH (20%): one patient had a persistent POVCH that required VCW. Fourteen other eyes (19%) had recurrent POVCH. Four (28%) of these 14 eyes with recurrent POVCH were classified as mild and 3 (21%) moderate: all cleared spontaneously with no further intervention needed. None of these had a trapezoidal image. Seven of the 14 eyes with recurrent POVCH were classified as major. Five of these 7 eyes had a trapezoidal image at 2 months postoperatively, and 4 required VCW (5.5% of total no. of eyes in study). All patients with a trapezoidal image experienced some degree of recurrent vitreous cavity hemorrhage (P = 0.0000024). The odds ratio was ?330:1. There was a significant correlation between the severity of POVCH and entry site appearance on ultrasound. In the first year of follow-up, all patients requiring VCW after recurrent POVCH had a trapezoidal image present at 2 months postoperatively (P = 0.009). Conclusion The appearance of a trapezoidal image on 20-MHz high-resolution anterior segment ultrasonography at a sclerostomy site after vitrectomy for PDR was highly correlated with the occurrence of nonclearing POVCH and need for VCW. Conversely, the absence of a trapezoidal image in patients with POVCH was associated with spontaneous hemorrhage clearance.

Item Type:	Article
Subjects:	A300 Clinical Medicine
Department:	Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User:	EPrint Services
Date Deposited:	12 Aug 2009 14:01
Last Modified:	31 Jul 2021 08:40
URI:	http://nrl.northumbria.ac.uk/id/eprint/834

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