Anterior retinal cryotherapy in diabetic vitreous hemorrhage.

American Journal of Ophthalmology (Impact Factor: 4.02). 10/1985; 100(3):440-4. DOI: 10.1016/0002-9394(85)90510-0
Source: PubMed

ABSTRACT Recurrent vitreous hemorrhage associated with proliferative retinopathy can occur in eyes that do not satisfactorily respond to argon laser pantretinal photocoagulation. To evaluate the effect of relatively low-risk surgical intervention, we performed peripheral retinal cryopexy on 24 eyes of 23 diabetic patients with proliferative diabetic retinopathy and vitreous hemorrhage. In most cases, cryopexy followed complete or nearly complete panretinal photocoagulation which did not prevent subsequent vitreous hemorrhage. Existing vitreous hemorrhage cleared postoperatively in 23 of 24 eyes. The best corrected visual acuity improved in 15 eyes, remained unchanged in five, and worsened in four. Four postoperative anterior segment complications resolved completely within a short time. One patient, a 68-year-old woman who had had diabetes for 18 years, postoperatively had a macular hole in one eye and macular edema with tractional retinal detachment in the other.

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    ABSTRACT: Abstract Purpose: To evaluate the efficacy of intravitreal bevacizumab (IVB) injection combined with anterior retinal cryotherapy (ARC) in the treatment of proliferate diabetic retinopathy (PDR) with vitreous hemorrhage (VH). Methods: A retrospective case controlled study was performed on 67 cases (67 patients) with PDR and persistent VH obscuring the fundus detail for ≧3 weeks. The follow-up period was ≧6 months. Cases with extensive vitreo-retinal adhesion by ultrasonography were excluded. In the study group, transconjunctival ARC (a total of 12 spots) followed by IVB 1.25 mg was performed in the same setting; in the control group, only IVB was given. Panretinal photocoagulation was performed when possible. Repeated IVB was performed in both groups if VH persisted for >4 weeks following the initial treatment. Vitrectomy was performed if VH showed no improvement for 12 to 16 weeks. The vitreous clear-up time (VCUT) in the posterior pole and the rate of vitrectomy were compared between the 2 groups. Results: In the study group (n=35), second treatment was required in 7 out of 35 patients (20.0%). Vitrectomy was performed in 5 (14.3%) patients. In the control group (n=32), 8 out of 32 eyes (25.0%) underwent second injection. Four eyes (12.5%) had vitrectomy within the follow-up time. VCUT in the study and the control group was 6.9±8.7 weeks and 13.0±9.3 weeks respectively (P=0.003). Conclusion: Combined treatment of ARC and IVB is associated with more rapid clearing of VH in eyes with PDR compared with IVB alone.
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    ABSTRACT: Zusammenfassung Die massive Glaskörperblutung stellt eine schwere Komplikation der proliferativen diabetischen Retinopathie dar. Sie wird als persistierend bezeichnet, wenn nach Binokulus mit Kopfhochlagerung kein Funduseinblick resultiert. Als Alternative zur Vitrektomie wurde Pankryopexie [1, 2, 5, 11, 13–16] durchgeführt, um so Funduseinblickverbesserung mit Laserbehandlungen in kleinen Schritten zu erreichen.Prospektive Studie: 27 Patienten mit persistierender massiver Glaskörperblutung bei Retinopathia diabetica proliferans. Visus: Lichtschein bis Fingerzählen. 12 Patienten mit Diabetes mellitus Typ I; 15 Typ II. Schlecht eingestellter Diabetes bei 13 Patienten mit HBA1C-Werten von 9,2% – 15%, Bluthochdruck bei 17 Patienten, Parästhesie der Füße bei 7, diabetische Nephropathie bei 6 (2 in Dialysebehandlung). Ultraschalluntersuchung: Blutung intrahyaloideal in 27, zusätzlich retrohyaloideal in 4 Augen. Rubeosis iridis Grad I bei 4 Augen, Grad II bei 8, Grad III bei 5, Grad IV bei 4.Therapie: Transkonjunktivale periphere Pankryopexie in Cocain-Anästhesie (5%) mit 8–14 Herden in oberer bzw. unterer Bulbuszirkumferenz. Kontrollen: In den ersten 6 Wochen aller 14 Tage, nach 6 Wochen, 3 Monaten und dann aller 6 Monate.Anatomisches Ergebnis: Nach Pankryopexie (n = 1 − 3) Laserbehandlungen in 23 Augen nach 2 – 4 Wochen; bei 5 dieser Patienten erneute Glaskörperblutung, Aufhellung durch erneute Pankryopexie. 2 Patienten Studie abgebrochen, 2 Patienten Vitrektomie trotz Pankryopexie.Funktionelles Ergebnis: Postoperativer Visusanstieg bei 25 Patienten (bei 23 auf 0,1–0,4); bei 2 Vitrektomie-Patienten nach primärem Anstieg Abfall auf Lichtschein bzw. Amaurose durch Sekundärkomplikationen.Komplikationen: Bei 25 Augen keine Kataraktentwicklung, Abnahme der Rubeosis; bei 2 Vitrektomie-Augen: Kataraktzunahme in 1 Auge (1 Auge Lensektomie), in beiden Augen Zunahme der Rubeosis iridis mit Sekundärglaukom bzw. Phthisis bulbi und nachfolgender Enukleation.Follow-up: 24 Patienten 2–3 1/2 Jahre, 2 (Studie abgebrochen) 6 bzw. 9 Monate; 1 Dialyse-Patient verstorben nach 20 Monaten. Summary A severe vitreous hemorrhage represents a serious complication in the course of proliferative diabetic retinopathy. Persistent means when after double patching with elevation of the head no fundus details become visible. In such eyes as an alternative to vitrectomy pancryopexy [1, 2, 5, 11, 13–16] was applied providing view to the retina with subsequent laser treatment in small steps.Prospective study: 27 patients with persistent severe vitreous hemorrhage in presence of proliferative diabetic retinopathy. Visual acuity: Light perception to counting fingers. 12 patients had diabetes mellitus type I; 15 type II. Thirteen diabetics had insufficient HBAb1C values of 9.2%–15%, high blood pressure in 17, paresthesia in the feet in 7, diabetic nephropathy in 6 (2 in dialysis-treatment). Ultrasonography: Hemorrhage intrahyaloidal in 27, retrohyaloidal in addition in 4 eyes. Rubeosis iridis grade I in 4 eyes, grade II in 8, grade III in 5, grade IV in 4.Therapy: Transconjunctival anterior pancryopexy in local anesthesia (cocaine 5%) with 8 – 14 lesions in superior or inferior circumference. Check-up: During the first 6 weeks every 2 weeks, after 6 weeks, 3 months and then at six-month intervals.Anatomical results: 2–4 weeks after pancryopexy (n = 1− 3) laser treatment in 23 eyes; in 5 eyes recurrent vitreous hemorrhage, clearing up after pancryopexy. 2 patients dropped out of study, 2 patients were vitrectomized in spite of pancryopexy.Functional results: Postoperative increase of visual acuity in 25 patients (in 23 between 20/ 200 − 20/50), in 2 vitrectomy patients after initial increase decrease to light perception or amaurosis due to secondary complications.Complications: In 25 eyes no development of cataract, but decrease of rubeosis iridis. In the 2 vitrectomized eyes: Increase of cataract in 1 eye (1 eye had lensectomy), in both eyes increase of rubeosis iridis resulting in secondary glaucoma or phthisis bulbi with subsequent enucleation of 1 eye.Follow-up: 24 patients 2–3 1/2 years, 2 (drop outs) 6 and 9 months respectively, 1 dialysis patient hat died after 20 months.
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