Prevention of intraoperative bleeding from neovascularization of the disc in complicated cases of proliferative diabetic retinopathy

Abstract

Proliferative diabetic retinopathy (PDR) is a major cause of vision loss in diabetic patients and is characterized by neovascularization particularly in optic nerve head (NVD). NVD may bleed spontaneously or be caused by minimal trauma. During vitrectomy, it is often difficult to stop this type of bleeding, thus surgeons are faced with such a problem as poor visualization and residual hemorrhage in the early postoperative period. Aim was to evaluate the clinical efficacy of the platelet-rich plasma (PRP) use in intraoperative bleeding from the NVD during the surgical treatment of PDR. Material and Methods. The group consists of 12 patients (12 eyes). Preoperative examination of all patients revealed the vitreous hemorrhage as well as the retinal traction detachment according to B-scan. A standard three-port vitrectomy (25 g) was performed, accompanied with the removal of proliferated blood vessels, diathermic coagulation, endolaser coagulation of the retina and an intravitreal injection of PRP on the NVD (PRP obtained by one-step closed centrifugation). Vitreal cavity was tamponaded with air. Results. We achieved an almost complete cessation of bleeding into vitreal cavity from NVD in all participants by using the intravitreal injection of the PRP. Conclusion. Intravitreal injection of PRP on the optic disc during vitrectomy is effective and safe. Keywords: proliferative diabetic retinopathy, PDR , neovascularization of the disc, vitreous hemorrhage, platelet-rich plasma, PRP, vitrectomy