Abstract
Purpose :
Vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR) can preclude panretinal photocoagulation (PRP). The clearance of VH may be hastened with intravitreal anti-VEGF injections (IVI) or with prompt vitrectomy (VIT). In this study, eyes with first-time VH were treated with either primary IVI, primary VIT, or neither prior to PRP were followed longitudinally to ascertain differences in baseline characteristics and outcomes that can guide selection of IVI versus VIT as initial management of VH until PRP can be safely performed.
Methods :
In this retrospective study, two-year outcomes were reviewed for all patients diagnosed with first-time diabetic VH at an urban safety-net hospital between June 1, 2015 to December 31, 2021. Eyes with prior VH, VH due to other causes, or less than 12 months of follow-up were excluded.
Results :
508 eyes were included in this study. Group 1 had 199 eyes treated with primary IVI. Group 2 had 150 eyes treated with primary vitrectomy. Group 3 had 159 eyes which did not receive IVI nor vitrectomy within two years of VH onset. At baseline, Group 1 had more prior PRP treatment (Groups 1 vs. 2 vs. 3: 50% vs. 37% vs. 46%) and Group 2 had more tractional membranes or detachments (0% vs. 27% vs. 8%). Group 3 had significantly better baseline VA (20/250 vs. 20/500 vs. 20/150). Eyes treated with primary vitrectomy had significantly worse final VA (20/125 vs. 20/250 vs. 20/150) yet had lower persistence of VH (34% vs. 13% vs. 35%). Frequency of performing PRP, time to first PRP treatment, frequency of VH recurrence, and time to first VH recurrence was similar across all Groups. 6 out of 296 eyes (2.0%) that received IVIs during the study period developed "crunch" (e.g. tractional retinal detachment (TRD) within 6 weeks of the most recent injection).
Conclusions :
In the largest study comparing outcomes of naive diabetic VH treated with primary IVI versus VIT, we find that non-surgical management with or without IVI for eyes with good baseline VA and absence of tractional retinal pathology may be a safe alternative to primary vitrectomy for the initial management of diabetic VH. Treatment of PDR with PRP was able to be performed with similar frequency and timeliness across all treatment groups in this study.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.