Efficacy of intravitreal tranexamic acid for prevention of postoperative vitreous hemorrhage after vitrectomy with fibrovascular membranes removal in patients with proliferative diabetic retinopathy

Author: Marina Karliychuk (Ukraine)

Co-authors: Artem Urazov, Serhii Pinchuk

Purpose

Postoperative diabetic vitreous hemorrhage (PDVH) is a severe complication of pars plana vitrectomy (PPV) with removal of fibrovascular membranes in patients with proliferative diabetic retinopathy (PDR). The reported prevalence of PDVH (occurring 1 or more weeks after surgery) is between 20% and 30%. Many studies report that intravitreal anti-VEGF drugs administered before surgery can significantly reduce the probability of PDVH; however, other studies have contradicted these results and shown that these drugs fail to prevent PDVH. Tranexamic acid is a synthetic reversible competitive inhibitor to the lysine receptor found on plasminogen. The aim was to evaluate the efficacy of intravitreal tranexamic acid in reduction of the probability of PDVH occurring in patients who received PPV with removal of fibrovascular membranes due to PDR.

Setting/Venue

Bukovinian State Medical University Eye Microsurgery Center

Methods

This retrospective, observational, comparative study included 38 patients (38 eyes) who underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation and high-speed (10,000 cuts per minute) 25-gauge transconjunctival sutureless PPV with segmentation and removal of combined fibrovascular membranes. In group 1 (20 patients, 20 eyes) after the air-fluid exchange, 0.05 ml 0.05% of tranexamic acid was injected from the limbus via the pars plana using a 30-gauge needle. For standard cases, we used air as endotamponade (9 eyes) but for complicated cases (intraoperative retinal tear and extensive fibrovascular tissue dissection), gas (SF6) endotamponade (19 eyes) or silicone oil (10 eyes) was used. The gas volume reduced to about 30% of the vitreous cavity 3 days after surgery and was reabsorbed completely in 10 days. Main outcome measure was the occurrence of recurrent early vitreous hemorrhage. Time points for postoperative examinations were first day, first week, and first month.

Results

Patient characteristics were similar between both groups (intrvitreal tranexamic acid and control (group 2)) at baseline and no statistically significant differences were noted between the groups. All 38 eyes were given intravitreal aflibercept within 10 days prior to surgery. On the first postoperative day the rate of rebleeding in the intravitreal tranexamic acid group was 10.0% (2 eyes), which is significantly lower than the control group (38.8%, 7 eyes, p<0.05). The incidence of early manifest PDVH in first week was also significantly lower in the intravitreal tranexamic acid group than the group 2 (p<0.05). Later PDVH, in 1 month after surgery, occurred in 3 eyes (15.0%) in the group 1 and 7 eyes (38.8%) in the group 2. So, the incidence of PDVH in the intravitreal tranexamic acid group was significantly lower than the control group.

Conlusions

Intravitreal tranexamic acid was effective in reduction of the probability of early postoperative diabetic vitreous hemorrhage occurring in patients who received PPV with removal of fibrovascular membranes due to PDR.