Peripheral retinal cryotherapy for postvitrectomy diabetic vitreous hemorrhage in phakic eyes.
OBJECTIVE
To review the anatomic and visual outcomes of a consecutive series of phakic patients with postoperative diabetic vitreous hemorrhage (PDVH) who underwent revision vitrectomy with peripheral retinal cryotherapy.


METHODS
We performed a retrospective chart review of consecutive phakic patients who underwent revision vitrectomy for PDVH who also received peripheral retinal cryotherapy. Final corrected visual acuities after revision vitrectomy with peripheral retinal cryotherapy were compared to corrected visual acuities before and at the time of PDVH. Anatomic outcomes such as retinal attachment, vitreous hemorrhage, iris neovascularization, lens opacity, and anterior hyaloidal neovascularization were considered.


RESULTS
Nineteen (86%) of 22 eyes (21 patients) that underwent revision of vitrectomy and transscleral peripheral retinal cryotherapy for PDVH also received supplementary endolaser photocoagulation in the posterior pole. In 16 eyes (73%), no further vitreous hemorrhaging occurred after this procedure. In six eyes (27%), vitreous hemorrhage recurred after revision of vitrectomy and peripheral retinal cryotherapy but cleared spontaneously in three of these eyes. Of the three eyes with nonclearing recurrent vitreous hemorrhage after revision of vitrectomy and peripheral retinal cryotherapy, the cause for the vitreous hemorrhage was known for two: severe, progressive anterior hyaloidal neovascularization. With a mean follow-up +/- SD of 6.8 +/- 5.1 months (range, 0.5 to 19.5 months), final corrected visual acuity after revision of vitrectomy and peripheral retinal cryotherapy for PDVH improved over preoperative visual acuity (at which time vitreous hemorrhage was present) in 18 eyes (82%) because of removal of vitreous hemorrhage from the visual axis. However, final visual acuity reached or exceeded pre-PDVH visual acuity in only five of the 15 eyes for which pre-PDVH visual acuity was known.


CONCLUSIONS
For phakic eyes with nonclearing PDVH, peripheral retinal cryotherapy (often augmented, when possible, by additional posterior pole endolaser photocoagulation) may be used to supplement previous retinal ablative therapy during revision of vitrectomy. This procedure leads to anatomic stabilization and visual improvement in the majority of eyes. Transscleral peripheral retinal cryotherapy is often feasible in situations (such as media opacity) that preclude use of peripheral retinal endolaser or indirect laser photocoagulation.
Department of Ophthalmology, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA.
K A
KA
Neely
M W
MW
Scroggs
B W
BW
McCuen
D000328:Adult; D000368:Aged; D002386:Cataract / Q000209:etiology; D002387:Cataract Extraction; D017679:Cryotherapy; D003930:Diabetic Retinopathy / Q000601:surgery*; D005260:Female; D006801:Humans; D017075:Laser Coagulation; D007908:Lens, Crystalline; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012160:Retina / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects*; D014823:Vitreous Hemorrhage / Q000209:etiology / Q000601:surgery*