Current Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy

Annan, Jaafar El; Carvounis, Petros

doi:10.1097/iio.0000000000000027

Cited by 53 publications

(54 citation statements)

References 52 publications

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“…However, more than 30 years have elapsed since the DRVS and considerable advancements in surgical techniques and pharmacotherapy such as small gauge vitrectomy instrumentations, high‐speed vitrectomy machines and the use of anti‐vascular endothelial growth factors (anti‐VEGFs) agents have greatly improved the surgical and visual outcomes of diabetic vitrectomies. It is therefore currently advised to observe patients for 4 weeks for diabetic VH, and in absence of subjective improvement, vitrectomy should be performed to regain the vision rather than continued observation . There are evidences that intravitreal anti‐VEGF along with PRP may be an effective combination therapy for PDR and VH; however, one needs to be cautious regarding presence of tractional component, as it may worsen following anti‐VEGF injections …”

Section: Indications For Surgerymentioning

confidence: 99%

“…These angiogenic factors lead to the development of neovascular, buds from the retinal blood vessels. These neovascular tissues proliferate and invade the potential space between the retina and the posterior hyaloid face, and later, inside the posterior lamellae of cortical vitreous causing firm adhesions between the retina and vitreous . This process leads to fibrovascular nails or pegs, which keep the tangential traction anchored to retina.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…It is therefore currently advised to observe patients for 4 weeks for diabetic VH, and in absence of subjective improvement, vitrectomy should be performed to regain the vision rather than continued observation. 5 There are evidences that intravitreal anti-VEGF along with PRP may be an effective combination therapy for PDR and VH; however, one needs to be cautious regarding presence of tractional component, as it may worsen following anti-VEGF injections. 6…”

Section: Vitreous Haemorrhagementioning

confidence: 99%

See 2 more Smart Citations

Surgical treatment for diabetic vitreoretinal diseases: a review

Sharma

Fong

Lai³

et al. 2016

Clinical Exper Ophthalmology

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Over the past four decades, advancements in surgical instrumentations and techniques have significantly improved the postoperative anatomical and visual outcomes of patients with various diabetic vitreoretinal diseases. In particular, surgical interventions for previously serious and untreatable blinding proliferative diabetic retinopathy can now be performed, with much better results. The advents of micro incisional vitrectomy system with better visualization system like binocular indirect ophthalmomicroscope and stateof-the-art instrumentation revolutionized the era of diabetic vitrectomy. High-speed vitrectors, finer instruments, chromo-assisted vitrectomy and use of antivascular endothelial growth factors not only change the paradigm but also help achieve much better outcome after diabetic vitrectomies. In this review, we will discuss and summarize the indications, surgical considerations, surgical techniques, potential complications and outcomes of vitreoretinal surgery for diabetic eye diseases.

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Section: Indications For Surgerymentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Vitreous Haemorrhagementioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment for diabetic vitreoretinal diseases: a review

Sharma

Fong

Lai³

et al. 2016

Clinical Exper Ophthalmology

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“…In general, type 1 patients require more attention since they usually present more aggressive disease [1][2][3][4]24] . The first episode of VH must be given special consideration.…”

Section: Managementmentioning

confidence: 99%

Surgical Management and Techniques

Codenotti¹,

Iuliano²,

Maestranzi³

2017

Management of Diabetic Retinopathy

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Technical advancements have substantially extended the indications for surgery in diabetic retinopathy (DR) during the last 40 years, from the traditional indications including non-clearing vitreous hemorrhage, traction retinal detachment (RD), and traction-rhegmatogenous RD, to epiretinal membrane (ERM), vitreomacular traction, diffuse macular edema, neovascular glaucoma, and anterior hyaloid fibrovascular proliferation. The goals of vitreoretinal surgery in DR are multiple: clearing media opacities, release of traction (anteroposterior and/or tangential), segmentation and/or removal of traction bands, peeling of ERMs, hemostasis, laser photocoagulation, and tamponade of retinal breaks with gas or silicone oil. The best management is achieved with integrated care provided by physicians with expertise in medical management of diabetes and surgical care of DR. In this chapter, the indications for surgery, preoperative considerations, surgical techniques, and complications, together with their management, will be discussed.

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“…Panretinal photocoagulation (PRP) is still one of the gold standards for treating proliferative diabetic retinopathy (PDR), yet many patients have an incomplete response with subsequent risk of vitreous hemorrhage (VH) and vision loss [1][2][3][4][5]. Spaide and Fisher [1] pioneered the use of vascular endothelial growth factor (VEGF) antagonists in eyes with PDR and VH.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal ziv-aflibercept in diabetic vitreous hemorrhage

et al. 2020

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Background: To evaluate the safety and efficacy of intravitreal ziv-aflibercept (IVZ) in the management of vitreous hemorrhage (VH) in eyes with previously lasered proliferative diabetic retinopathy (PDR). Methods:In a prospective multicenter study, previously lasered eyes who had dense VH from PDR underwent intravitreal injection of ziv-aflibercept (IVZ) (1.25 mg aflibercept). Demographic characteristics of the patients, baseline and final logMar visual acuity, number of injections, VH clearance time, and need for vitrectomy were recorded.Results: Twenty-seven eyes of 21 patients were included in the study. Mean age of study patients was 61.3 ± 14.1 years with mean duration of diabetes mellitus of 22.6 ± 7.8 years. Mean logMAR BCVA at baseline was 1.41 ± 1.26 (Snellen equivalent 20/514) and at the last visit 0.55 ± 0.61 (Snellen equivalent 20/70) with a mean gain of 0.86 EDTRS line (paired student t test = 5.1; p ≤ 0.001). Mean number of IVZ 2.4 ± 1.6 (range 1-6). The mean follow-up time was 11.7 ± 11.1 months (range 1-34). Mean time for visual recovery and/or VH clearance was 5.7 ± 3.3 weeks. Eyes, which required multiple injections, the interval period between injections for recurrent VH was 6.4 ± 5.2 months. No subject required vitrectomy. No ocular or systemic adverse effects were noted.Conclusions: IVZ injections had good short-term safety and efficacy for the therapy of new or recurrent VH in previously lasered eyes with PDR reducing somewhat the need for vitrectomy. Trial registration: NCT02486484

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Current Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy

Cited by 53 publications

References 52 publications

Surgical treatment for diabetic vitreoretinal diseases: a review

Surgical treatment for diabetic vitreoretinal diseases: a review

Surgical Management and Techniques

Intravitreal ziv-aflibercept in diabetic vitreous hemorrhage

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