Intraoperative Ocular Blood Flow Dynamics in Response to Intraocular Pressure Fluctuations During Vitrectomy for Proliferative Diabetic Retinopathy

TL;DR

This study examines how optic nerve blood flow responds to pressure changes during vitrectomy in diabetic retinopathy patients.

Contribution

The study provides new insights into the autoregulatory response of optic nerve blood flow during intraocular pressure changes in PDR patients.

Findings

Intraoperative IOP elevation reduced optic nerve blood flow by 29%.

Blood flow recovered to baseline levels after IOP normalization.

Short-term autoregulatory capacity is preserved in PDR patients during vitrectomy.

Abstract

Background/Objectives: This study aimed to evaluate the autoregulatory capacity of optic nerve head (ONH) tissue blood flow in response to intraocular pressure (IOP) fluctuations during vitrectomy in patients with proliferative diabetic retinopathy (PDR). We hypothesized that impaired autoregulation of ONH tissue blood flow in response to intraoperative IOP fluctuations could contribute to subsequent ONH atrophy and the development of visual field defects in PDR patients following vitrectomy. Methods: We included five eyes from five patients with PDR (mean age 70.6 ± 9.0 years) undergoing 25-gauge pars plana vitrectomy. ONH tissue blood flow was quantitatively assessed using intraoperative laser speckle flowgraphy. Mean blur rate in the tissue area (MT), an indicator of ONH tissue blood flow, was measured at baseline (infusion pressure 0 mmHg), during sustained elevation to 25 mmHg (at 5 and 10 min), and 1 min after return to baseline (11 min). IOP was modulated using the IOP Control system of the Constellation platform. Results: Elevation of IOP to 25 mmHg significantly reduced ONH tissue blood flow, with MT decreasing by 29% at 10 min compared with baseline (p < 0.05, Dunn’s multiple comparisons test). After IOP returned to baseline, MT significantly recovered compared with the 10 min measurement (p < 0.05) and returned to levels not significantly different from baseline (p > 0.05). Conclusions: MT decreases during intraoperative IOP elevation in PDR undergoing vitrectomy, but recovers after the return to baseline pressure, suggesting preserved short-term autoregulatory capacity. Careful IOP management during vitrectomy remains important in eyes with PDR.

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