Simultaneous injection\u2010aspiration technique of air/fluid exchange for in\u2010office treatment of post\u2010operative vitreous cavity hemorrhage

Riley N Sanders,Sami H Uwaydat

doi:10.1186/s40942-021-00282-z

Abstract

BackgroundPost-operative vitreous cavity hemorrhage following pars plana vitrectomy is common. In-office drainage of the hemorrhage may be an option for some patients.TechniqueA new method for office-based air fluid exchange is described. A 30-gauge needle with a 10-mm syringe filled with sterile air is inserted 3.5-mm posterior to the limbus in the superotemporal quadrant. A second 30-gauge needle is inserted 3.5 mm from the limbus at 6 o’clock and connected to an empty 10-mm syringe with intravenous catheter tubing. The plunger of the air-filled syringe is pushed while the plunger of the empty syringe is pulled, so that the rate of fluid aspiration matches the rate of air injection.DiscussionThe method approximates conditions in pars plana vitrectomy, with balanced infusion and aspiration. Displaced vitreous cavity contents are collected in the aspiration syringe. The procedure is also cost effective.ConclusionThe simultaneous syringe method is an easy, safe, and effective way of clearing post-operative vitreous cavity hemorrhage.

Highlights

Post-operative vitreous cavity hemorrhage (POVCH) is a common occurrence after pars plana vitrectomy (PPV), prolonging visual recovery
POVCH can be classified in two main forms: (1) early/persistent bleeding, usually from oozing of dissected neovascular tissue and sclerostomy sites, and (2) late/recurrent, often from anterior fibrovascular ingrowth (FVI) or entry site neovascularization [1]
Over 90% of POVCH will clear within 5–6 weeks [3], but when significant hemorrhage persists longer, additional procedures may be required to clear the blood [3]

Summary

Introduction

Post-operative vitreous cavity hemorrhage (POVCH) is a common occurrence after pars plana vitrectomy (PPV), prolonging visual recovery. Intraoperative strategies during PPV to reduce incidence of POVCH include adequate removal of posterior vitreous, Methods for in-office fluid-fluid exchange [5] and airfluid exchange [6,7,8,9] have been described. These involve either a one-needle open system [7, 9]; or a two-needle. A 30-gauge needle with a 10-mm syringe filled with sterile air is inserted 3.5-mm posterior to the limbus in the superotemporal quadrant. The plunger of the air-filled syringe is pushed while the plunger of the empty syringe is pulled, so that the rate of fluid aspiration matches the rate of air injection

Objectives

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Conclusion