Management of post-vitrectomy persistent vitreous hemorrhage in pseudophakic eyes

Abstract

Purpose To prospectively assess the effect of neodymium:yttrium-aluminum-garnet peripheral capsulotomy on postvitrectomy hemorrhage in diabetic patients with a posterior chamber intraocular lens (IOL) implant and an intact posterior capsule. Design Interventional case series. Methods This is a prospective case series, clinical practice. Patients Five vitrectomized, diabetic, pseudophakic patients with persistent vitreous cavity hemorrhage remaining after vitrectomy were selected. They all had a posterior chamber IOL implant with an intact posterior capsule. Additionally, they had all undergone laser panretinal photocoagulation in the involved eye in the past for diabetic retinopathy. Neodymium:yttrium-aluminum-garnet laser capsulotomy outside the optic of the IOL was performed in victrectomized diabetic patients to treat the remaining vitreous cavity hemorrhage. Visual acuity, intraocular pressure (IOP), and fundus examination were measured and done immediately after the laser procedure, in 7 days and in approximately 3 months. Results The visual acuity was improved at the time of the first follow-up. However, a mild elevation of IOP was noticed in some patients, which was treated with topical dorzolamide. The final visual acuity was dramatically improved, to 20/30 or better, and the IOP was normalized without medication within a few weeks in all five cases. No neovascularization of the iris or elsewhere was noticed in any case. Conclusions Neodymium:yttrium-aluminum-garnet laser peripheral capsulotomy appears to be a safe and effective management procedure in treating postvitrectomy hemorrhage in diabetic patients who have previously undergone cataract surgery with posterior chamber lens implant, intact posterior capsule, and extensive panretinal photocoagulation. The vitreous hemorrhage cleared completely in all five cases.