PERIPHERAL RETINAL CRYOTHERAPY FOR POSTVITRECTOMY DIABETIC VITREOUS HEMORRHAGE IN PHAKIC EYES

PURPOSE: To review the anatomic and visual outcomes of a consecutive s eries of phakic patients with postoperative diabetic vitreous hemorrha ge (PDVH) who underwent revision vitrectomy with peripheral retinal cr yotherapy. METHODS: We performed a retrospective chart review of conse cutive phakic patients who underwent revision vitrectomy for PDVH who also received peripheral retinal cryotherapy, Final corrected visual a cuities after revision vitrectomy with peripheral retinal cryotherapy were compared to corrected visual acuities before and at the time of P DVH, Anatomic outcomes such as retinal attachment, vitreous hemorrhage , iris neovascularization, lens opacity, and anterior hyaloidal neovas cularization were considered. RESULTS: Nineteen (86%) of 22 eyes (21 p atients) that underwent revision of vitrectomy and transscleral periph eral retinal cryotherapy for PDVH also received supplementary endolase r 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 perip heral 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, progressi ve anterior hyaloidal neovascularization, With a mean follow-up +/- SD of 6.8 +/- 5.1. months (range, 0.5 to 19.5 months), final corrected v isual acuity after revision of vitrectomy and peripheral retinal cryot herapy for PDVH improved over preoperative visual acuity (at which tim e vitreous hemorrhage was present) in 18 eyes (82%) because of removal of vitreous hemorrhage from the visual axis, However, final visual ac uity reached or exceeded pre-PDVH visual acuity in only five of the 15 eyes for which pre-PDVH visual acuity was known, CONCLUSION: For phak ic eyes with nonclearing PDVH, peripheral retinal cryotherapy (often a ugmented, when possible, by additional posterior pole endolaser photoc oagulation) may be used to supple ment previous retinal ablative thera py during revision of vitrectomy. This procedure leads to anatomic sta bilization and visual improvement in the majority of eyes. Transsclera l peripheral retinal cryotherapy is often feasible in situations (such as media opacity) that preclude use of peripheral retinal endolaser o r indirect Laser photocoagulation. (C) 1998 by Elsevier Science Inc, A ll rights reserved.