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Clinical Outcomes of Early vs Delayed Vitrectomy for Vitreous Hemorrhage Secondary to Proliferative Diabetic Retinopathy
TAKE-HOME MESSAGE
- As with the 1985 findings of the Diabetic Retinopathy Vitrectomy Study, which showed improved outcomes with early pars plana vitrectomy (PPV), this retrospective study also showed that, in eyes with vitreous hemorrhage resulting from proliferative diabetic retinopathy, early (within 6 weeks) PPV resulted in improved visual acuity at 12 months compared with delayed (later than 6 weeks) PPV.
- These findings reinforce the importance of early PPV for diabetic vitreous hemorrhage for best visual outcomes. Nevertheless, further randomized clinical trials are indicated.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To compare the clinical outcomes of early pars plana vitrectomy (PPV) versus delayed PPV in patients with first episode of vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR).
DESIGN
Retrospective, comparative, interventional study.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS
Consecutive patients with type 1 or II diabetes diagnosed with new onset VH secondary to PDR who underwent PPV at Moorfields Eye Hospital between December 2014 and December 2016. Exclusions were prior vitrectomy, iris neovascularization, neovascular glaucoma, macular edema, or presence of tractional/rhegmatogenous retinal detachment.
METHODS, INTERVENTION, OR TESTING
Patients were divided into two groups based on the timing of their surgery: early PPV (≤6 weeks) and delayed PPV (>6 weeks). Demographic and clinical features, including best-corrected visual acuity (BCVA) expressed in LogMAR at baseline and 12 months were collected. Statistical analyses, including propensity score matching, were performed using Python 3.10, Scikit-learn, Pandas, and GraphPad Prism® 10.
MAIN OUTCOME MEASURES
BCVA at 12 months postoperatively, reoperation rates, and severity of complications.
RESULTS
A total of 178 eyes were analyzed (48 early PPV, 130 delayed PPV). The mean (SD) number of weeks before surgery was 3.36 (SD 1.6) for the early PPV group and 22.56 (SD 17.23) for the delayed PPV group (p<0.0001). Baseline BCVA prior to PPV was similar between groups (p=0.08). At 12 months, the early PPV group had significantly better BCVA (0.40 logMAR vs. 0.67 logMAR; p=0.02). Patients without evidence of posterior vitreous detachment (PVD) on ultrasound or OCT showed more pronounced differences (0.3 logMAR vs. 0.7 logMAR; p=0.001). The early PPV group had fewer sight threatening complications (p=0.005). Multivariable logistic regression identified initial BCVA, early PPV, and absence of pre-operative panretinal photocoagulation (PRP) as significant predictors of better visual outcomes.
CONCLUSIONS
Early PPV significantly improves visual outcomes and reduces severe complications in patients with VH secondary to PDR. These findings support the benefits of early surgical intervention to enhance long-term visual prognosis in these patients. However, a randomised clinical trial is warranted.
Additional Info
Early versus Delayed Vitrectomy for Vitreous Haemorrhage Secondary to Proliferative Diabetic Retinopathy
Am J Ophthalmol 2024 Oct 27;[EPub Ahead of Print], R Anguita, L Ferro Desideri, P Schwember, N Shah, S Ahmed, A Raharja, J Roth, S Sivaprasad, L WickhamFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
There were 178 participant eyes included in this study, aimed at comparing the outcomes of early pars plana vitrectomy (PPV) versus delayed PPV in patients presenting with a first episode of vitreous hemorrhage secondary to proliferative diabetic retinopathy. Early vitrectomy was defined as vitrectomy occurring within 6 weeks from the onset of vitreous hemorrhage. The authors concluded that early PPV was associated with improved visual outcomes and fewer severe complications. Specifically, early vitrectomy reduced the likelihood of vision impairment by approximately 60%. Other significant findings and the possible reasons for these observations are discussed.
A very surprising finding was that patients who underwent preoperative panretinal photocoagulation had approximately 3.6 times higher odds of moderate visual impairment than those who underwent intraoperative panretinal photocoagulation. The discussion of the mechanism underlying this finding should be of great significance to retinal specialists. This study has the potential to impact the clinical decision–making of retinal specialists and, therefore, is particularly significant.