Guruprasad S. Ayachit, MS (Hubli, India), Paul E. Tornambe, MD (Poway, CA)

PURPOSE:

When transpupillary laser ablation is not feasible, does direct retinal ablation by endolaser and cryotherapy result in regression of NVI, control of IOP and preservation of vision? Is the surgery fraught with any risks?

METHODS:

A prospective, interventional, noncomparative case series. 14 patients with PDR with no previous laser and recalcitrant NVG were chosen for this procedure. All patients had corneal haze not clearing with the maximum dose of antiglaucoma drugs. All patients had severe NVI and high IOP > 30 mmHg. 9 eyes presented with vision of less than 1/60, and 2 eyes with finger counting close to face and 3 eyes with just PL. All eyes underwent a pars plana vitrectomy with endolaser and anterior retinal cryotherapy. Cataract removal with IOL implantation was required in 8 cases to facilitate vitreous surgery.

RESULTS:

Outcome measures – Regression of NVI, control of IOP, and associated findings and complications. All patients had post surgical follow-up of 6 months or greater. Lowering of IOP and regression of NVI was achieved in 10 patients. 3 patients continued to have NVI and high IOP and in 1 patient there was severe intraoperative bleed requiring abandoning of surgery. Antiglaucoma surgery was performed in 7 patients at a later date. The final visual acuity was 1/60 or better in 9 eyes.

CONCLUSION:

In apparently hopeless cases of PDR and severe NVG where ciliary ganglion ablation, cyclodestructive procedures or enucleation seem the only options Vitreous surgery with a good retinal ablation seems to provide hope and should be considered at least in cases with some visual potential.