Pars plana vitrectomy under air infusion versus conventional fluid infusion for dense vitreous hemorrhage: a retrospective comparative study

Abstract Background Vitreous hemorrhage (VH) remains a significant clinical challenge in vitreoretinal surgery. Conventional pars plana vitrectomy (PPV) under balanced salt solution (BSS) infusion is limited by poor intraoperative visualization when hemorrhagic vitreous mixes with the irrigating solution. Vitrectomy under air infusion has been proposed as an alternative approach that may overcome these limitations. This study aimed to compare the surgical efficiency and short-term outcomes of vitrectomy under air infusion versus conventional BSS infusion in the management of dense vitreous hemorrhage. Methods This retrospective comparative study included 32 eyes of 32 patients who underwent 23-gauge PPV for vitreous hemorrhage at a single center between August 2024 and August 2025. Sixteen eyes received air infusion (air group) and 16 eyes received conventional BSS infusion (BSS group). All surgeries were performed by the same surgeon. Primary outcome was effective vitrectomy time. Secondary outcomes included best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured by optical coherence tomography (OCT) at 1 month postoperatively, as well as intraoperative and postoperative complications. Results Baseline demographics and clinical characteristics were comparable between groups. The mean effective vitrectomy time was shorter in the air group than in the BSS group (4.17 ± 0.97 min vs. 5.02 ± 1.18 min; p = 0.033; Cohen’s d = 0.79). At 1-month follow-up, BCVA (0.336 ± 0.24 vs. 0.366 ± 0.36 logMAR; p = 0.785) and CMT (298.815 ± 132.45 vs. 265.750 ± 98.91 μm; p = 0.430) were comparable between groups. No intraoperative complications occurred in either group. Postoperative complications at 1 month occurred in 3 eyes (18.8%) in the BSS group and 1 eye (6.3%) in the air group; the study was not powered to compare complication rates. Conclusions Vitrectomy under air infusion was associated with a shorter effective vitrectomy time than conventional BSS infusion, while achieving comparable short-term visual and anatomical outcomes. The air–vitreous interface may improve intraoperative visualization of hemorrhagic vitreous. As the two techniques produced equivalent short-term outcomes, the potential advantage of air infusion appears to lie in intraoperative efficiency rather than in superior clinical results. Larger prospective studies with longer follow-up are warranted to confirm these findings.