Abstract
Purpose :
Vitreous hemorrhage (VH) from PDR is a frequent cause of visual acuity (VA) loss in diabetics, but the optimal management strategy is unclear. We compared the effect of initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation (PRP) on VA and the ability to perform regular activities
Methods :
Adults at 39 sites in US and Canada, with VA loss due to VH from PDR, were randomly assigned to initial treatment with aflibercept (N=100) or vitrectomy with PRP (N=105) and followed for 2 years. Aflibercept treatment began with 4 monthly injections. All eyes could receive aflibercept or vitrectomy during follow-up per prespecified criteria. The primary outcome was mean VA over 24 weeks (area under the curve)adjusted for baseline VA. Secondary outcomes included VA at 4 weeks and 2 years and the percentage of activity impairment due to VA on the Workplace Productivity and Impairment Questionnaire (100%=completely prevented regular activities; 0%=no effect).
Results :
At baseline, mean age was 57 years, 115 (56%) were male, and mean VA was 34.5 letters (Snellen equivalent (SE) 20/200). Over 2 years, 33 aflibercept group eyes (33%) received vitrectomy and 34 vitrectomy group eyes (32%) received aflibercept. Excluding deaths, 90% completed the 2-year visit. Mean VA over 24 weeks was 59.3 vs 63.0 letters (SE 20/63 vs 20/63) with aflibercept vs vitrectomy (adjusted difference=-5.0, 95% CI, -10.2 to 0.3; P=.06), respectively. At 4 weeks, mean VA was 52.6 letters vs 62.3 letters (SE 20/100 vs 20/63) with aflibercept vs vitrectomy (adjusted difference=-11.2 [95% CI, -18.5 to -3.9] P = .003) and at 2 years, 73.7 vs 71.0 (SE 20/40 vs 20/40) (adjusted difference=2.7 [95% CI, -3.1 to 8.4], P= .36) letters, respectively. The mean reduction in activity impairment due to VA over 24 weeks with aflibercept was 21% versus 27% with vitrectomy (adjusted difference=7% [95% CI, 1% to 13%], P=.02); at 2 years, the difference was 3% (P=.31).
Conclusions :
Among eyes with vitreous hemorrhage due to PDR, there was no significant difference in mean VA over 24 weeks after initiating treatment with aflibercept vs vitrectomy with PRP. Initial vitrectomy improved participants’ VA and ability to perform daily activities faster than aflibercept.
This is a 2021 ARVO Annual Meeting abstract.