The authors describe a modified diabetic vitrectomy using continuous air infusion in diabetic eyes with severe fibrovascular proliferation. In their case series of 25 eyes (20 patients), intravitreal bevacizumab (1.25mg) was used one week prior to surgery. Fifteen eyes had vitrectomy done under air and the remaining 15 eyes were done under balanced salt solution (BSS), which is the conventional way of performing surgery. In the air vitrectomy group, fluid-air exchange was performed after posterior hyaloid separation. One confounding factor was, however, the use of perfluorocarbon liquids (PFCL) in both groups when there were severe adherent membranes (in three and two eyes respectively). Anatomical and visual outcomes were similar in both groups, but it was noted that vitrectomy time was significantly shorter in the air vitrectomy group. Because the surface tension of air is higher than fluid, an air bubble confines haemorrhages and avoids its diffusion into the vitreous cavity. This allows better identification of intraocular structures. Furthermore, it increases the field of view where visualisation beyond the equator into the ora serrata is possible. The authors acknowledge a learning curve for this technique, but postulate that this may help in complex diabetic vitrectomies.
Control of bleeding with diabetic vitrectomy under air
Reviewed by Kurt Spiteri Cornish
Air-perfused 23-gauge sutureless diabetic vitrectomy for control of intraoperative bleeding during removal of fibrovascular membrane.
CONTRIBUTOR
Kurt Spiteri Cornish
Sheffield Teaching Hospitals NHS Trust, London, UK.
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