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Janelle Marie Fassbender, AHMET OZKOK, Hannah Canter, Shlomit Schaal; A comparison of early and delayed vitrectomy for management of vitreous hemorrhage due to proliferative diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5117.
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To compare early and delayed vitrectomy for the management of vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR).
Retrospective review of 52 patients who underwent vitrectomy for non-clearing VH secondary to PDR. Patients were excluded if they had prior vitrectomy, follow up < 1 month post-operatively, other retinal pathology, VH secondary to other causes, retinal detachment, uveitis, or advanced glaucoma. Primary outcome was area under the vision curve (AUC) in patients receiving early (< 30 days) versus delayed (> 30 days) vitrectomy. Secondary analyses included number and frequency of PRP sessions, anti-VEGF therapy, and post-surgical complications. Demographics were compared by Mann-Whitney U test, effect of primary and secondary analyses were evaluated by Student’s T-test, and p<0.05 was considered significant.
37 eyes (71.1%) were included, 12 had early vitrectomy while 25 had delayed. There was no difference between the groups in terms of age, race, gender, diabetes control, or diabetes duration. Average time to surgery was 531.41+/-877.34 days. Time spent with decreased vision pre-operatively was significantly longer for patients undergoing delayed versus early vitrectomy (AUC 255.86 LogMar*time vs 176.45 LogMar*time, respectively; p<0.05). Patients in the delayed group with severe vision loss (>1.3 LogMar) also had significantly increased time with vision loss (AUC 434.04 LogMar*time vs 233.16 LogMar*time; p<0.01). There were no differences in AUC post-operatively for delayed versus early surgery. Both groups required fewer post-op PRP sessions:26 (70.2%) eyes had pre-op PRP (4.5+/-3.94, 250-spot sessions) while 3 (8.1%) had post-op (p<0.01). There were no differences between pre- and post-op bevacizumab within or between groups. Pre-op and final visual acuities were equivalent, including 30-day (0.41+/-0.25 vs 0.71+/-0.81) or 1-year (0.28+/-0.12 vs 0.37+/-0.33), in early versus delayed vitrectomy, respectively. Complications within 1 year were rare and did not vary by technique of surgery.
Early vitrectomy for VH due to PDR significantly decreases time spent with vision loss, and decreases need for further PRP sessions. Modern vitrectomy surgery is safe and may be considered earlier in VH management.<br /> This project is supported by a non-restricted institutional grant from Research to Prevent Blindness
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