Cover Image

Office-based Air-Fluid Exchange for Diabetic Post-Operative Vitreous Cavity Hemorrhage

Alice W. BEHRENS, Sami H. UWAYDAT, Joshua S. HARDIN, Ahmed B. SALLAM

Abstract


Post-operative vitreous cavity hemorrhage (POVCH) is observed in 6-75% of eyes undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). We describe our technique for office-based Air fluid exchange (AFX) in the treatment of POVCH. Sixteen eyes (15 patients) with PDR and POVCH undergoing office-based AFX between January 2006 and November 2016 were retrospectively identified. The pre- and post- procedure visual acuity (VA) and complications were compared between eyes with and without traction retinal detachment (TRD). Medicare charges for office-based AFX versus PPV were also analyzed. Mean age at the time of AFX was 55.31 (± 8.02) years. Nine eyes (56.25%) had TRD prior to PPV and 11 eyes (68.75%) were pseudophakic. The improvements in mean (± standard deviation [SD]) logMAR VA at the last postoperative visit (3 - 8 months) were 1.38 (± 0.99), 0.82 (± 0.91) and 2.09 (± 0.53) in all eyes, TRD eyes and non-TRD eyes, respectively. Complications included cataract progression, hypotony, and recurrence of TRD and ghost cell glaucoma. The total cost of outpatient AFX was $1,409.59 less than that of PPV. Office-based AFX is a cost-effective alternative treatment for non-clearing diabetic POVCH with an acceptable risk profile.


References


Tolentino FI, Cajita VN, Gancayco T, Skates S. Vitreous hemorrhage after closed vitrectomy for proliferative diabetic retinopathy. Ophthalmology. 1989;96(10):1495-500. doi: 10.1016/s0161-6420(89)32700-x pmid: 2587044

Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology. 1983;90(5):522-30. doi: 10.1016/s0161-6420(83)34540-1 pmid: 6192378

Novak MA, Rice TA, Michels RG, Auer C. The crystalline lens after vitrectomy for diabetic retinopathy. Ophthalmology. 1984;91(12):1480-4. doi: 10.1016/s0161-6420(84)34100-8 pmid: 6521988

Steel DH, Connor A, Habib MS, Owen R. Entry site treatment to prevent late recurrent postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol. 2010;94(9):1219-25. doi: 10.1136/bjo.2009.170126 pmid: 19955203

Yorston D, Wickham L, Benson S, Bunce C, Sheard R, Charteris D. Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92(3):365-8. doi: 10.1136/bjo.2007.124495 pmid: 18303158

Virata SR, Kylstra JA. Postoperative complications following vitrectomy for proliferative diabetic retinopathy with sew-on and noncontact wide-angle viewing lenses. Ophthalmic Surg Lasers. 2001;32(3):193-7. pmid: 11371085

Landers MB, 3rd, Robinson D, Olsen KR, Rinkoff J. Slit-lamp fluid-gas exchange and other office procedures following vitreoretinal surgery. Arch Ophthalmol. 1985;103(7):967-72. pmid: 4015489

Blankenship GW. Management of vitreous cavity hemorrhage following pars plana vitrectomy for diabetic retinopathy. Ophthalmology. 1986;93(1):39-44. doi: 10.1016/s0161-6420(86)33791-6 pmid: 2419815

Han DP, Murphy ML, Mieler WF, Abrams GW. Outpatient fluid-air exchange for severe postvitrectomy diabetic vitreous hemorrhage. Long-term results and complications. Retina. 1991;11(3):309-14. pmid: 1961989

Martin DF, McCuen BW, 2nd. Efficacy of fluid-air exchange for postvitrectomy diabetic vitreous hemorrhage. Am J Ophthalmol. 1992;114(4):457-63. doi: 10.1016/s0002-9394(14)71858-6 pmid: 1415457

Lange C, Feltgen N, Junker B, Schulze-Bonsel K, Bach M. Resolving the clinical acuity categories "hand motion" and "counting fingers" using the Freiburg Visual Acuity Test (FrACT). Graefes Arch Clin Exp Ophthalmol. 2009;247(1):137-42. doi: 10.1007/s00417-008-0926-0 pmid: 18766368

Jackson TL, Johnston RL, Donachie PH, Williamson TH, Sparrow JM, Steel DH. The Royal College of Ophthalmologists' National Ophthalmology Database Study of Vitreoretinal Surgery: Report 6, Diabetic Vitrectomy. JAMA Ophthalmol. 2016;134(1):79-85; quiz 120. doi: 10.1001/jamaophthalmol.2015.4587 pmid: 26584210

Centers for Medicare and Medicaid Services. CY 2017 Physician Fee Schedule: Centers for Medicare and Medicaid Services; 2017 [cited 2019 March 3]. Available from: https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx.

Centers for Medicare and Medicaid Services. ASC Payment Rate-Addenda: Centers for Medicare and Medicaid Services; 2019 [cited 2019 March 3]. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/11_Addenda_Updates.html.

Centers for Medicare and Medicaid Services. CY 2017 PFS Final Rule Calculation of the National Average Anesthesia Conversion Factor: Centers for Medicare and Medicaid Services; 2017 [cited 2018 March 30]. Available from: https://www.cms.gov/apps/ama/license.asp?file=/Medicare/Coding/NationalCorrectCodInitEd/downloads/ccigrp1.zip.

Erie JC, Baratz KH, Hodge DO, Schleck CD, Burke JP. Incidence of cataract surgery from 1980 through 2004: 25-year population-based study. J Cataract Refract Surg. 2007;33(7):1273-7. doi: 10.1016/j.jcrs.2007.03.053 pmid: 17586386

Stark WJ, Sommer A, Smith RE. Changing trends in intraocular lens implantation. Arch Ophthalmol. 1989;107(10):1441-4. pmid: 2803089

Helbig H, Kellner U, Bornfeld N, Foerster MH. Rubeosis iridis after vitrectomy for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 1998;236(10):730-3. doi: 10.1007/s004170050150 pmid: 9801886

Mason JO, 3rd, Colagross CT, Vail R. Diabetic vitrectomy: risks, prognosis, future trends. Curr Opin Ophthalmol. 2006;17(3):281-5. doi: 10.1097/01.icu.0000193098.28798.18 pmid: 16794442

Lin X, Apple D, Hu J, Tewari A. Advancements of vitreoretinal surgical machines. Curr Opin Ophthalmol. 2017;28(3):242-5. doi: 10.1097/ICU.0000000000000369 pmid: 28257298

Figueroa M, Panico C, Faraldi F, Mariotti C, Arias L, Grosso A. Recent Advancements in Vitreoretinal Techniques – A Critical Reappraisal. Eur Ophthal Rev. 2014;08(01):46. doi: 10.17925/eor.2014.08.01.46


Full Text: Free Full Text PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.