Anterior Hyaloidal Fibrovascular Proliferation After Diabetic Vitrectomy Hilel Lewis, M.D., Gary W. Abrams, M.D., and George A. Williams, M.D. Vitrectomy was performed to treat 74 con- secutive eyes for complications of diabetic ret- inopathy. Eight (13%) of 61 eyes followed up for an average of 12 months developed anterior hyaloidal fibrovascular proliferation. This was the most common postoperative complication, whose features included recurrent hemorrhag- es into the vitreous cavity or anterior vitreous, or both; vessels or fibrovascular tissue on the posterior lens capsule; anterior extraretinal vascularization extending toward the lens on the anterior hyaloid; traction detachment of the peripheral retina or ciliary body; and hypotony. Patients who developed this com- plication tended to be young males with severe retinal neovascularization and extensive reti- nal ischemia; traction retinal detachment as an indication for surgery; placement of a scleral buckle; postoperative rubeosis iridis, recur- rent vitreous hemorrhages, and retinal detach- ment; and multiple surgeries. Four eyes pro- gressed to atrophia bulbi. Early recognition followed by additional surgery in two patients and extensive additional photocoagulation in two other patients was successful in preserv- ing good visual function. ANTERIOR HYALOIDAL fibrovascular prolifera- tion is the most common severe postoperative complication occurring after vitrectomy for dia- betic retinopathy. It is characterized by fibro- vascular proliferation originating from the anterior retina and extending along the ante- rior hyaloid to the posterior lens surface. Se- Accepted for publication Aug. 17, 1987. From the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin. This study was supported in part by Research to Prevent Blindness, Inc, and a Fight for Sight, Inc., grant (Dr. Lewis). Reprint requests to Hilel Lewis, M.D., Wilmer Oph- thalmological Institute, Maumenee 205, 600 N. Wolfe St., Baltimore, MD 21205. vere visual loss results from hemorrhages into the vitreous cavity or anterior hyaloid, cataract formation, or peripheral traction retinal and ciliary body detachments, which frequently re- sult in atrophia bulbi. 1 To determine the prevalence of this complica- tion and to identify prognostic indicators for its development we analyzed a consecutive series of 74 eyes that underwent vitrectomy for com- plications of diabetic retinopathy. Material and Methods Between Jan. 1, 1984, and Aug. 31, 1986, 74 eyes of 66 patients underwent vitrectomies per- formed by two of us (G.W.A. and G.A.W.) for treatment of complications of diabetic retinopa- thy. Of these 74 eyes we excluded seven eyes that had previous vitreous surgery and six eyes that were followed up for less than six months. Thus, a total of 61 eyes of 55 patients were included in this study. Vitrectomy was per- formed in most eyes for traction retinal detach- ment involving the macula with or without vitreous hemorrhage (18 eyes, 29.5%), non- clearing vitreous hemorrhage (17 eyes, 28%), and combined traction-rhegmatogenous retinal detachment (17 eyes, 28%). The remaining nine eyes had surgery for other indications, includ- ing progressive fibrovascular proliferation or extramacular traction retinal detachments with vitreous hemorrhage. The surgical approach used was a three-port pars plana vitrectomy using endoillumination. Areas of proliferation were either isolated by circumscribing the posterior hyaloid attach- ments to the vascular epicenters where they originated from the retina, or, more recently, excised using en bloc resection. 2 Panretinal argon laser endophotocoagulation was used in all patients except those who already had ex- tensive panretinal photocoagulation before ©AMERICAN JOURNAL OF OPHTHALMOLOGY 104:607-613, DECEMBER, 1987 607