Early vitrectomy may decrease time with vision loss in eyes with vitreous hemorrhage

Immediate vitrectomy with endolaser may reduce the amount of time a patient has low vision and the need for adjunctive panretinal photocoagulation in eyes treated for vitreous hemorrhage associated with proliferative diabetic retinopathy, according to a study.

Perspective from Carl D. Regillo, MD, FACS

The retrospective study included 46 eyes; 17 eyes underwent vitrectomy within 30 days of initial presentation and 29 eyes underwent vitrectomy after 30 days.

Average time to vitrectomy was 14.8 days in the immediate vitrectomy group and 629.6 days in the delayed vitrectomy group.

Preoperatively, the area under the vision curve was 276.1 logMAR*time in the delayed group and 165.7 logMAR*time in the immediate group; the between-group difference was statistically significant (P < .0001). Postoperatively, the area under the vision curve was 163.6 logMAR*time and 122 logMAR*time, respectively. The postoperative between-group difference was not significant, but both improvements were significant (P < .0001 and P = .0001, respectively).

Both groups needed significantly less adjunctive PRP after vitrectomy (P < .05). Nine eyes (52.9%) in the immediate group and 21 eyes (72.4%) in the delayed group underwent PRP before vitrectomy. Three (17.6%) in the immediate group and one eye (3.2%) in the delayed group underwent PRP after vitrectomy.

Preoperative visual acuity was 1.86 in the immediate group and 1.71 in the delayed group. Postoperative visual acuity at 6 months or final follow-up was 0.35 in the immediate group and 0.31 in the delayed group; the improvements were statistically significant in both groups (P = .002 and P < .0001, respectively). The differences between the groups were not significant before or after surgery. – by Matt Hasson

Disclosure: The authors report no relevant financial disclosures.

Perspective

Carl D. Regillo, MD, FACS

This retrospective study by Fassbender and colleagues shows similar outcomes with faster recovery of vision along a trend for less PRP sessions before surgery with early pars plana vitrectomy (PPV) and PRP for non-clearing vitreous hemorrhage from proliferative diabetic retinopathy (PDR). Although this is not a prospective, randomized trial, any selection bias would be for more advanced disease in the early intervention group, yet the outcomes were equivalent. Furthermore, because PPV with PRP these days commonly results in permanent, complete PDR regression and infrequent significant recurrent postoperative vitreous hemorrhages, it is highly likely that there is both direct medical (eg, anti-VEGF injections, laser treatments, ultrasounds, office visits) and indirect nonmedical (eg, travel to office, time out of work) cost savings with early surgical intervention.

Carl D. Regillo, MD, FACS

OSN Retina/Vitreous Board Member

Disclosures: Regillo reports no relevant financial disclosures.

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Sources/Disclosures

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Source:

Fassbender JM, et al. Ophthalmic Surg Lasers Imaging Retina. 2016;doi:10.3928/23258160-20151214-05.