Ophthalmology Department, Guy's and St Thomas' Hospital, London, United Kingdom.
Retina. 2023 Mar 1;43(3):520-522. doi: 10.1097/IAE.0000000000002833. Epub 2020 May 13.
To investigate the effectiveness of an intraoperative surgical technique to reduce the incidence of immediate postoperative cavity hemorrhage in patients undergoing vitrectomy for complications of proliferative diabetic retinopathy.
A single-center, prospective study of 20 consecutive patients who underwent vitrectomy for proliferative diabetic retinopathy-related complications. A standard 3-port pars plana vitrectomy with either 23 g or 25 g was performed. At the end of surgery, the infusion was switched off to create transient hypotony and endolaser photocoagulation with long-duration burns were applied to actively leaking blood vessel.
The average age was 56.2 + 12.8 years. Eleven eyes had actively bleeding vessels at the end of surgery and received endolaser photocoagulation. No patients were found to have hypotony at Day 1 postoperative. Preoperative median visual acuity was 20/1,600 improving to 20/40 at a median of 2.3 weeks post-op (range 0.4-8.5 weeks). Two eyes (10%) had a small postoperative cavity hemorrhage with 20/40 vision, which did not require further intervention.
The described technique was found to be effective in reducing the incidence of postoperative cavity hemorrhage from up to 75% reported in literature to 10% in our pilot study. Further study with a larger number of patients is required.
研究一种术中手术技术，以降低接受增生性糖尿病视网膜病变并发症玻璃体切除术患者术后即刻发生腔隙性出血的发生率。
对 20 例连续接受增生性糖尿病视网膜病变相关并发症玻璃体切除术的患者进行单中心前瞻性研究。采用标准的 3 端口经睫状体平坦部玻璃体切除术，使用 23g 或 25g 套管。手术结束时，关闭灌注以产生短暂的低眼压，并对活跃渗漏的血管进行长时间的激光光凝。
平均年龄为 56.2+12.8 岁。11 只眼在手术结束时有活跃的血管出血，并接受了激光光凝。术后第 1 天没有发现低眼压的患者。术前的平均视力为 20/1600，术后中位数为 2.3 周（范围 0.4-8.5 周）提高至 20/40。两只眼（10%）术后出现小的腔隙性出血，视力为 20/40，无需进一步干预。
与文献报道的高达 75%的术后腔隙性出血发生率相比，我们的初步研究发现该技术可有效降低术后腔隙性出血的发生率。需要进一步研究更多的患者。
