Timing of optimal surgical intervention for vitreous hemorrhage in patients with proliferative diabetic retinopathy

Abstract

Background：To explore the optimal timing of vitrectomy for vitreous hemorrhage in the patients with proliferative diabetic retinopathy (PDR).Method：Seventy-six PDR patients (85 eyes) who were diagnosed with vitreous hemorrhage and received vitrectomy were retrospectively enrolled into this study. The patients were categorized into 4 groups based on the timing of surgical intervention after the occurrence of hemorrhage, namely Group 1 (less than 15 days, with 28 eyes of 27 patients), Group 2 (15~30 days, with 29 eyes of 27 patients), Group 3 (30~90 days, with 14 eyes of 11 patients) and Group 4 (>90 days, with 14 eyes of 11 patients). Best corrected visual acuity (BCVA) and central macular thickness (CMT) from OCT before and at 1 mo and 3 mo after operation were collected as the main outcomes. The postoperative complications were also reported.Result: 1) BCVA (logMAR): the mean pre-operation BCVA was not significantly different among the 4 groups (P=0.139), while the mean post-operation BCVA was significantly worse in groups with longer gap between the vitreous bleeding and the vitrectomy, both at 1m and 3m after surgery (P=0.043; P<0.001). 2) CMT(μm): Although CMT was unavailable to measure in most included eyes before surgery, the mean CMT was significantly thicker in groups with postponed surgical intervention both at 1-month (P=0.001) and at 3-month (P=0.006) after surgery. 3) Complications: No severe complications were spotted in early vitrectomy groups (Group 1 and Group 2) during the follow-up period. At 3 months after the operation, three cases of ocular hypertension and another case of neovascular glaucoma in Group 3 and 4 cases of ocular hypertension and another 3 cases of neovascular glaucoma in Group 4 were observed. Conclusion: Early vitrectomy is more effective in improving BCVA and decreasing CMT in the PDR patients with vitreous hemorrhage. Moreover, the post-operation complications were spotted less in early vitrectomy groups. Thus we suggested that vitrectomy should be performed early and better within one month after the onset of vitreous hemorrhage in PDR patients.

Vitrectomy in Diabetic Retinopathy

“…The results of DRVS showed that eyes undergoing early vitrectomy for severe vitreous haemorrhage were more likely to have VA ≥ 20/40 at 2 years and greatest benefit was seen in patients with type 1 diabetes [10]. With the evolution of better surgical techniques and instruments (MIVS), early vitrectomy is more effective in achieving better visual outcomes [11]. Usually, patients with type 1 or type 2 diabetics with VH and no underlying traction, can be observed for 1 month [12].…”