Slit‐Lamp‐Guided 30‐Gauge Air‐Fluid Exchange: An Efficient Office‐Based Intervention for Postvitrectomy Vitreous Hemorrhage in Diabetic Retinopathy

Purpose Recurrent vitreous hemorrhage (VH) complicating pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) often delays visual recovery and poses a management challenge. We assessed the efficacy and safety of a minimally invasive, office‐based alternative—slit‐lamp‐guided 30‐gauge air‐fluid exchange (AFE). Methods This retrospective study included 33 eyes of 33 patients who underwent 30G‐AFE for VH following PPV. Patients Were Stratified by Time to Rebleeding early (≤ 30 days, n = 22), intermediate (31–90 days, n = 6), and late (> 90 days, n = 5). Primary outcomes were changes in best‐corrected visual acuity (BCVA) and time to visual recovery (Snellen ≥ 20/200). Secondary outcomes included the reoperation rate and complications. Results Mean BCVA (LogMAR) significantly improved from 2.41 ± 0.38 preoperatively to 0.68 ± 0.41 at 3 months postoperatively ( p < 0.01). The early group had the shortest mean time to visual recovery (6.5 ± 2.1 days) and the most favorable BCVA at 1 month (LogMAR 0.62 ± 0.39), which was significantly better than the intermediate and late groups ( p < 0.01). Three eyes (9.1%) required repeat PPV. Transient ocular hypertension occurred in 5 eyes (15.2%) and was medically controlled. No retinal detachment or endophthalmitis occurred. Conclusions Slit‐lamp‐guided 30G‐AFE is an effective, safe, and economical office‐based intervention for managing VH after PPV in PDR. Its efficacy, however, is strongly time dependent. Visual outcomes were superior when the procedure was performed for early rebleeding, suggesting that timing may be a critical factor for therapeutic success. This technique represents a valuable minimally invasive alternative to repeat vitrectomy.