| Purpose:To investigate and analyze the causes of severe vitreous hemorrhage after vitrectomy in eyes with proliferative diabetic retinopathy(PDR), and to evaluate the therapeutic effects.Methods:Retrospective, noncomparative, interventional case series. From Jan. 2005 to Dec.2009,236 patients (292 eyes) with proliferative diabetic retinopathy(PDR) were accepted with vitrectomy.43 patients(50 eyes) had severe postoperative vitreous hemorrhage,41 patients(48 eyes) were accepted with vitrectomy in our hospital,2 patients(2 eyes) were offered from other hospitals. According to the examination of the iris by the slit lamp, the fundus statues by the indirect ophthalmoscope, the amount of vitreous hemorrhage and whether there had retinal detachment to be or not through ocular B-scan if the fundus were not be observed clearly, and the records in the reoperations, investigate and analyze the causes,therapies,complications of PDVH. All the clinical data were analyzed by the statistical software of SPSS 13.0 (Statistical Package for the Social Science).Results:The occurrence of PDVH was 16.2%. In the 50 eyes, C3F8 tamponade eyes occupied 23 (46%), silicone oil tamponade eyes occupied 17 (34%), air tamponade eyes occupied 7(14%), and infusion solution tamponade eyes occupied 3 (6%).40 eyes (80%) rehemorrhaged occurred 7-170 days (average 62.5 days) after vitrectomy,7 days in 5 eyes(12.5%),7 days to 30 days in 8 eyes (20%),30 days to 90 days in 18 eyes (45%) and more than 90 days in 9 eyes (22.5%).10 eyes (20%) rehemorrhaged occurred 1-60 days (average 27.4 days) after silicon oil remival,14 days in 3 eyes(30%),14 days to 60 days in 5 eyes (50%),60 days to 90 days in 1 eye (10%), more than 90 days in 1 eye (10%). The time of PDVH:one time in 36 eyes (72%), two times in 10 eyes(20%), three and more than three times in 4 eyes(8%). The causes of PDVH included chronic errhysis from retinal neovessels (NVE) in 33 eyes (47.1%), residual fibrous vascular membrane in 9 eyes (12.8%), fibrovascular ingrowth at the site of sclera incision in 3eyes (4.3%), iris neovessels and neovascular glaucoma occurred in 3 eyes (4.3%), branch of retinal vein occlusion in 2 eyes (2.8%), retinal tears in 5eyes(8.1%), retinotomy in 1 eye(1.4%), epichoroidal space bleeding in 1 eye (1.4%), polycythemia rubra vera in 1 eye (1.4%), hypoperfusional retinopathy caused by ocular hypotension and ocular artery occlusion after treatment of ciliary body photocoagulation and cryotherapy in 3eyes (4.3%), etiology unknown in 9 eye (12.8%).Because there are more than one reason of vitreous hemorrhage during some patients, all statistical eyes were 70 eyes other than 50 eyes, percentage ratio was replaced of constituent ratio).4 (8%) eyes were treated without operationg, the hemorrhage was absorbed in 3 eyes and aggravated in 1 eye which were not treated in the following time. After the retreatment, the visual acuity increased in 3 eyes (75%), unchanged in leye (25%).46 eyes (92%) are accepted operations such as fluid-air exchange, removal of residual neovascularization membrane on the optic nerve and retina, cryotherapy for fibrovascular at the incision site combined with local cryotherapy and electrocoagulation of the vascular stump, complementary retinal photocoagulation and so on, which the hemorrhage were not absorpted in one month. Recurrent vitreous hemorrhage was not found in 34 eyes after one time of operation,12 eyes were underwented more than one time of operation, recurrent vitreous hemorrhage, were not found in 8 eyes,4 eyes were tamponad with silicone oil permanently because of recurrent vitreous hemorrhage again and again, which were so-called silicone oil dependent eyes. The visual acuity increased in 36 eyes (78.3%), decreased in 4 eyes (8.7%) and unchanged in 6 (13%). At the end of the follow-up period, the visual acuity was no light perception in 2 eyes (4%), hand moving in 11 eyes (22%), counting finger-0.02 in 13 eyes(26%),0.03 -0.1 in 13 eyes(26%) and over 0.1 in 11 eyes (22%).Conclusion:PDVH are more commonly occurred 2 months after vitrectomy for PDR. The main causes of PDVH included residual epiretinal neovascularization membrane, fibrovascular membrane or inappropriately treated vascular stump on the surface of optic nerve or retina, chronic errhysis from neovessels elsewhere, fibrovascular ingrowth at the site of sclera incision, retinal tears etc. Appropriate management of insection sites, completely removal of residual neovascularization membrane on the optic nerve and retina, electrocoagulation of the vessel stump and sufficient retinal photocoagulation, retinal laser photocoagulation after operation can prevent and treat rehemorrhage after vitrectomy of PDR. Active treatment for severe vitreous hemorrhage can obviously improve the patients' visual prognosis.
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