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

Abstract Post-operative vitreous cavity hemorrhage (POVCH) is observed in ۶-۷۵% 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 (۱۵ patients) with PDR and POVCH undergoing office-based AFX between January ۲۰۰۶ and November ۲۰۱۶ 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 ۵۵.۳۱ (± ۸.۰۲) years. Nine eyes (۵۶.۲۵%) had TRD prior to PPV and ۱۱ eyes (۶۸.۷۵%) were pseudophakic. The improvements in mean (± standard deviation [SD]) logMAR VA at the last postoperative visit (۳ - ۸ months) were ۱.۳۸ (± ۰.۹۹), ۰.۸۲ (± ۰.۹۱) and ۲.۰۹ (± ۰.۵۳) 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 ۱,۴۰۹.۵۹ less than that of PPV. Office-based AFX is a cost-effective alternative treatment for non-clearing diabetic POVCH with an acceptable risk profile.