Early Vitrectomy and Endolaser Photocoagulation in Patients with Type I ]Diabetes with Severe Vitreous Hemorrhage

Abstract

To determine if adjunctive endolaser photocoagulation has further improved the outcome of early vitrectomy for severe vitreous hemorrhage in young patients with type I insulin-dependent diabetes. The authors reviewed clinical records and fundus photographs of all primary diabetic vitrectomies performed at the Yale Eye Center between July 1986 and June 1993. Only young patients with type I diabetes who underwent vitrectomy within 6 months of vitreous hemorrhage were included. Of 197 vitrectomies for diabetic retinopathy, 12 eyes of ten patients met the Diabetic Retinopathy Vitrectomy Study Group criteria. Patients ranged in age from 24 to 29 years (mean, 27.3 years) and had 11 to 21 years (mean, 17.2 years) of history of diabetes. Preoperative visual acuity was 5/200 in seven eyes, 2/200 in three eyes, hand motions in one eye, and light perception in one eye. The duration of vitreous hemorrhage was approximately 1 month in two eyes, 1 to 3 months in five eyes, and 3 to 6 months in five eyes. Neovascularization was documented in 12/12 eyes. Preoperatively, all patients had received panretinal photocoagulation with 1937 to 5328 burns (mean, 4126). Postoperative follow-up ranged from 12 to 38 months (mean, 24.6 months). Best-corrected postoperative visual acuity was 20/40 or better in 7 eyes (58.33%) and 20/70 or better in 11 eyes (91.66%). Neovascularization involuted in 11/12 eyes and remained so till the last follow-up. Patients with type I diabetes with severe vitreous hemorrhage benefit from early endolaser photocoagulation combined with current vitrectomy techniques. The authors' findings are consistent with those of the Diabetic Retinopathy Vitrectomy Study Group, and patients can expect both improved visual acuity and anatomic success.