Abstract
Purpose :
To assess the efficacy and safety of vitrectomy with intravitreous ranibizumab instead of panretinal photocoagulation (PRP) for vitreous hemorrhage from proliferative diabetic retinopathy (PDR) and to study proper timing of PRP.
Methods :
This was a prospective and interventional study of patients with vision loss due to vitreous hemorrhage from PDR. Patients underwent vitrectomy combined with intraoperative and postoperative intravitreal injection of ranibizumab without intraoperative PRP. All the eyes were operated by the same surgeon to complete the vitrectomy and received initially 3 injections. Additional injections were received according the neovascular, macular edema and visual acuity. The results of best-corrected visual acuity (BCVA), central subfield thickness (CST), diabetic retinopathy severity score (DRSS), visual field (VF) and intraoperative complications were evaluated during follow-up.
Results :
13 eyes of 13 patients (5 females) were enrolled and the mean age was 48 ± 12 years. The mean duration of vitreous hemorrhage was 2.69 ±1.84 months and the mean result of HbA1c was 8.19 ±1.46%. During 24 to 36 months follow-up, mean BCVA improved significantly from 1.10 ± 0.56 logMAR (Snellen equivalent, 20/252) preoperatively to 0.10 ± 0.13 logMAR (Snellen equivalent, 20/25) postoperatively. The mean preoperative intraocular pressure was 14.1 ± 3.7mmHg and the mean postoperative result was 15.6 ± 3.9mmHg. The mean CST was 248.2 ± 57.9μm at one month postoperatively and 263.2 ± 56.8μm at final visit. The MD of VF was -9.6 ± 5.6dB at 3 months and -5.9 ± 3.8dB at 12 months operatively. The mean postoperative DASS was 44 ± 5.6 at 3 months and remained 43.2 ± 8.3 at final visit. The mean number of injections over 2 years was 4.4 ± 1.5 in first year and 0.9 ± 1.2 in second year, respectively. One of the patients suffered tractional retinal detachment and received reoperation. Neovascular glaucoma occurred in two of the patients but no additional operation for glaucoma was need.
Conclusions :
Vitrectomy with intravitreous ranibizumab is safe and effective for simple vitreous hemorrhage from PDR. The DASS kept low score with a quite acceptable low times of intravitreous injection. The retina survived with deferred or without PRP and kept the possibility of recovery in the future.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.