Air-Perfused 23-Gauge Sutureless Diabetic Vitrectomy for Control of Intraoperative Bleeding during Removal of Fibrovascular Membrane

Abstract

Purpose: To demonstrate the advantages and efficacy of an air-perfused membrane dissection to control intraoperative bleeding in 23-gauge sutureless vitrectomy for proliferative diabetic retinopathy with severe fibrovascular membranes. Meterials and Methods: A prospective, consecutive, interventional case series of 15 eyes that underwent air-perfused diabetic vitrectomy (air vitrectomy group) for removal of the membranes was compared with a retrospective, membrane-matched case series of 10 eyes that underwent conventional diabetic vitrectomy (conventional vitrectomy group). The main outcome measures were real vitrectomy time, intraoperative and postoperative complications, and anatomic and functional successes at the final examination. Results: The incidence of intraoperative retinal tears was 30% (3/10 eyes) in the conventional vitrectomy group and 20% (3/15 eyes) in the air vitrectomy group (p > 0.05). The postoperative complications such as vitreous hemorrhage or tractional retinal detachment were not common in both groups during the 6-month follow-up (p > 0.05). In addition, the final anatomic and functional success rates did not differ significantly between the groups (p > 0.05). However, the vitrectomy time was significantly shorter in the air vitrectomy group (67.0 +/- 21.8 min) than in the conventional group (84.6 +/- 21.1 min) (p = 0.04). Conclusion: Air-perfused vitrectomy showed comparable anatomic and functional success rates and shorter surgical time, compared with conventional vitrectomy in diabetic eyes with severe fibrovascular membranes. We suppose that the shortened surgical time in the air vitrectomy group is related to less intraoperative bleeding and more efficient hemostasis.