Visual Acuity, Vitreous Hemorrhage, and Other Ocular Outcomes After Vitrectomy vs Aflibercept for Vitreous Hemorrhage Due to Diabetic Retinopathy

Abstract

IMPORTANCEAlthough there were no differences in mean visual acuity (VA) over 24 weeks after vitrectomy with panretinal photocoagulation (PRP) vs aflibercept in a randomized clinical trial among eyes with vitreous hemorrhage due to proliferative diabetic retinopathy (PDR), post hoc analyses may influence treatment choices.OBJECTIVE To compare exploratory outcomes between treatment groups that may affect treatment choices for patients with vitreous hemorrhage due to PDR. DESIGN, SETTING, AND PARTICIPANTSThis post hoc analysis of a randomized clinical trial conducted at 39 DRCR Retina Network sites included adults with vision loss due to PDR-related vitreous hemorrhage for whom vitrectomy was considered. Data were collected from November 2016 to January 2020.INTERVENTIONS Random assignment to 4 monthly injections of aflibercept vs vitrectomy with PRP. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol-specific criteria. MAIN OUTCOMES AND MEASURESVisual acuity area under the curve (adjusted for baseline VA) and clearance of vitreous hemorrhage.RESULTS A total of 205 eyes were included in the analysis (115 male [56%] and 90 [44%] female participants; mean [SD] age, 57 [11] years). Among 89 eyes with a baseline VA of 20/32 to 20/160 (47 receiving aflibercept, including 4 [9%] that had undergone vitrectomy; 42 undergoing vitrectomy, including 3 [7%] that had received aflibercept), the adjusted mean difference in VA letter score over 24 weeks between the aflibercept and vitrectomy groups was −4.3 (95% CI, −10.6 to 1.9) compared with −16.7 (95% CI, −24.4 to −9.1) among 59 eyes with baseline VA worse than 20/800 (P = .02 for interaction; 26 in the aflibercept group, including 6 [23%] that had undergone vitrectomy; 33 in the vitrectomy group, including 8 [24%] that had received aflibercept). In the full cohort, the median time to clearance of the initial vitreous hemorrhage was 36 (interquartile range [IQR], 24-52) weeks in the aflibercept group vs 4 (IQR, 4-4) weeks in the vitrectomy group (difference, 32 [95% CI,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) weeks; P < .001). CONCLUSIONS AND RELEVANCEBoth initial aflibercept and vitrectomy with PRP are viable treatment approaches for PDR-related vitreous hemorrhage. Although this study did not find a significant difference between groups in the primary outcome of mean VA over 24 weeks of follow-up, eyes receiving initial vitrectomy with PRP had faster recovery of vision over 24 weeks when baseline VA was worse than 20/800 and faster vitreous hemorrhage clearance. Approximately one-third of the eyes in each group received the alternative treatment (aflibercept or vitrectomy with PRP). These factors may influence treatment decisions for patients initiating therapy for PDR-related vitreous hemorrhage.

Outcomes of Pars Plana Vitrectomy with Panretinal Photocoagulation for Treatment of Proliferative Diabetic Retinopathy Without Retinal Detachment: A Seven-Year Retrospective Study

“… 16 However, their study demonstrated faster recovery of vision when baseline vision was worse than 20/800 and quicker clearance of VH in eyes that underwent initial vitrectomy with PRP. 17 The current study and Protocol AB both demonstrated the safety and efficacy of PPV with PRP for PDR with VH; an optimal approach to PDR is still likely use of traditional first-line in-office options followed by PPV if necessary and indicated.…”

Diagnostik, Therapie und Verlaufskontrolle der diabetischen Augenerkrankung (Update 2023)

“…Treten als Folge der diabetischen Retinopathie Komplikationen wie Netzhautablösung, Glaskörperblutung und/oder eine Rubeosis iridis auf, spricht man von einer fortgeschrittenen diabetischen Augenerkrankung. Neben Vitrektomie inklusive Entfernung eventuell vorhandener Netzhautmembranen und -traktionen und panretinaler Laserkoagulation (Netzhautablösung, Glaskörperblutung), sowie anti-VEGF IVOM (Glaskörperblutung [35,36]) können bei Sekundärglaukom auch zyklodestruktive (=den Ziliarkörper verödende) Verfahren wie Zyklophotokoagulation oder Implantation eines drucksenkenden Drains indiziert sein. Weitere Details zur Lizenz entnehmen Sie bitte der Lizenzinformation auf http://creativecommons.org/licenses/by/4.…”

Incidence of early complications requiring treatment plan changes after vitreoretinal surgery: a single-center study in South Korea

“…Modern vitreoretinal surgery is safe and effective in treating various retinal disorders, including rhegmatogenous retinal detachment (RRD), [ 1 ] complications of diabetic retinopathy, [ 2 ] macular hole (MH), [ 3 ] and epiretinal membrane (ERM) [ 4 ]. However, since vitreoretinal surgery is invasive, postoperative complications, such as increased (2.5–61.5%) or decreased (1.8–13.1%) intraocular pressure (IOP), [ 5 – 10 ] corneal edema (0.80–1.1%) [ 7 , 11 ], intraocular inflammation (0.25–26%) [ 5 , 12 ], or retinal detachments (1.2–1.7%) may occur in patients [ 11 ].…”