Intravitreal ranibizumab for Vitreous hemorrhage in Proliferative Diabetic Retinopathy

Abstract

Purpose: The aim of our study is to investigate the effect of ranibizumab on a cohort of patients with vitreous hemorrhage with respect to change in visual acuity, rate of vitrectomy and rate of recurrence; as compared to a control group treated with observation alone.

Methods: This is a prospective cohort study that included a cohort of real-life patients with presumed PDR who presented with persistent vitreous hemorrhage (> 2 weeks duration) to Eye and Ear University hospital between June 2006 and June 2010. Patients were randomized to two groups: “Ranibizumab group” was treated with intravitreal injections of ranibizumab and “Control group” was observed closely for spontaneous resolution. VH was also graded into mild/moderate and severe according to its density and extent. In both groups, vitrectomy was carried out if there was no improvement in the VH after 3 months. In the “Ranibizumab group”, intravitreal injection of ranibizumab was repeated if there was an improvement of VA at the one month follow up visit or if there was partial clearing of vitreous hemorrhage as evidenced by fundus examination.

Results: 133 patients were included in the study. 71 patients were in the group A (mean age 67.9±10.2) and 62 patients were in the group B ( mean age 69.4±8.5) . Cumulative probability of vitrectomy by 16 weeks was 24% with ranibizumab group vs 35% with Control group (p= 0.144). Recurrence of VH occurred within 16 weeks in 31% % and 47 %, in Ranibizumab group and Control group respectively. (P= 0.06). There was a significant difference in the cumulative probability of vitrectomy by 16 weeks in patients with mild-moderate VH between ranibizumab and Control groups (16% and 39% respectively; p= 0.04). The cumulative probability of vitrectomy by 16 weeks in patients with severe VH was similar between ranibizumab and Control groups ( 30% and 32 % respectively; p= 0.831). Also, this study found consistently better visual acuity in the ranibizumab group at 2, 4, 12 and 16 weeks post op compared to the control group.

Conclusions: In our study, the need for vitrectomy was lower in patients with mild to moderate VH in the ranibizumab group as compared to control group. Intravitreal ranibizumab injection could be considered in patients with VH in PDR especially if the VH is mild to moderate.

Keywords: 499 diabetic retinopathy • 763 vitreous • 561 injection