This review aimed to systematically compare the efficacy and safety of intravitreal aflibercept (IVA) and vitrectomy for treating severe vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). The review was conducted in accordance with PRISMA guidelines. A search strategy, including the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US National Library of Medicine databases, was developed to identify randomized controlled trials (RCTs) that compared vitrectomy and IVA for managing VH due to PDR (participant age ≥ 18 years). The primary outcome measure was the difference in the mean visual acuity between the two treatment groups at 1, 6, and 24 months. Outcome measures included clearance of VH (in weeks), the incidence of recurrent VH, and the rate of complications. The studies were evaluated using the Cochrane Bias (ROB) tool. We identified 774 articles; six articles met the inclusion criteria, and two were ultimately included (n = 239 eyes). With or without PRP, IVA injections and vitrectomy were performed in 117 and 122 eyes, respectively. The mean BCVA at one month was significantly better in the vitrectomy group (MD=0.22, CI:0.10–0.34, p=0.0003), but no difference was found at six months (MD=0.04, CI: −0.04–0.12, p=0.356). The incidence of recurrent VH was significantly higher in the IVA group (OR=5.05, CI:2.71–9.42, p<0.0001). The probability of recurrent VH was five times greater in the IVA group than that in the vitrectomy group. There were no significant differences in the overall proportions of intra- or postoperative complications (OR=0.64, CI: 0.09–4.85, p=0.669). None of the studies had a low ROB in any of the seven domains. We conclude that IVA can be considered a viable treatment modality for diabetic VH in patients with a good follow-up. Vitrectomy initially provides better visual effect, faster VH recovery, and lower VH recurrence than IVA injections.

Background Information about long term perfusional status of patients who have undergone successful surgery for giant retinal tear (GRT) macula-off rhegmatogenous retinal detachment (RRD) is limited. Purpose To examine long term perfusional, structural, and functional outcomes in normal control eyes and the eyes treated for different degrees of GRT-associated extensions of RRD. Methods One emmetropic normal eye (control), one healthy highly myopic eye (control myopic), and three eyes surgically treated for GRT (surgical), were included in the study for a long-term comparison of study outcomes. The surgical eyes were classified based on the degree of GRT-associated RRD extension as follows: One eye with GRT-associated RRD extension < 180°, one eye with GRT-associated RRD extension between 180°–270°; and one eye with GRT-associated RRD extension > 270°. Structural, functional, and perfusional outcomes were compared with those of control eyes. Results All three included eyes were phakic and the condition was monocular. The mean age of the patients was 48.67 ± 8.50 years (range, 39–55 years). All three eyes had GRT macula-off RRD. The mean preoperative time for GRT surgery was 1.2 weeks. The mean pre- and postoperative best corrected visual acuities (BCVA) were 1.87 logMAR and 0.46 logMAR, respectively. The mean postoperative follow-up period was 19.67 ± 5.69 months. Proliferative vitreoretinopathy (PVR) resulted in multiple surgeries in one eye (31.5%). Long-term postoperative optical coherence tomography (OCT) showed abnormal retinal thickness, ellipsoid zone (EZ) disruption, and external limiting membrane (ELM) line discontinuities in one eye. OCT angiography yielded abnormal perfusion indices in the surgically treated eyes. Conclusions Our data showed multiple structural alterations in spectral-domain OCT biomarkers. One eye that developed secondary epiretinal membrane (ERM) proliferation showed a significantly improved BCVA after proliferation, and the internal limiting membrane (ILM) were removed. Perfusional findings were correlated with final BCVA. Despite a fully reattached retina without ERM proliferation, GRT-associated RRD has a guarded functional prognosis.