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Early vitrectomy reduces time with vision loss in eyes with vitreous hemorrhage
The cost of treatment was seven times higher among patients who had delayed vitrectomy compared with those who had immediate vitrectomy.
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Immediate vitrectomy with endolaser may reduce the amount of time a patient has low vision in eyes treated for vitreous hemorrhage associated with proliferative diabetic retinopathy, according to a study.
Overall, vitrectomy significantly reduced the need for postoperative panretinal photocoagulation (PRP) in eyes that underwent immediate or delayed vitrectomy.
“This study shows that people who underwent vitrectomy benefited most if the vitrectomy was within 30 days of bleeding. The message is, don’t wait,” corresponding author Shlomit Schaal, MD, PhD, told Ocular Surgery News.
Schaal said it may be time to change the guidelines on when to perform vitrectomy in eyes with vitreous hemorrhage associated with proliferative diabetic retinopathy.
“The reason that we did this study is that the guidelines for when to do a vitrectomy for vitreous hemorrhage due to diabetic retinopathy haven’t changed over the last 30 years,” she said. “There was the Diabetic Retinopathy Vitrectomy Study, which was a large randomized, controlled study. Back then, the vitrectomy technique was quite different than it is today. It was only 20 gauge. Everything was different. They didn’t even have endolaser photocoagulation, so they found back then that it’s best to wait before you do a vitrectomy.”
Schaal said there is a need for a randomized controlled study to compare immediate vitrectomy with delayed vitrectomy in eyes with vitreous hemorrhage resulting from diabetic retinopathy.
Vitrectomy review
The retrospective review, published in Ophthalmic Surgery, Lasers and Imaging Retina, included 46 eyes; 17 eyes underwent vitrectomy within 30 days of initial presentation and 29 eyes underwent vitrectomy after 30 days. Time to vitrectomy was 14.8 days in the immediate vitrectomy group and 629.6 days in the delayed vitrectomy group.
The primary outcome measure was area under the vision curve (AUC), or time spent with low vision denoted as logMAR*time.
“The y axis was vision, and the x axis was time. The calculation of area under the curve mainly says how long the patient was with low vision,” Schaal said.
Investigators also assessed visual acuity, complications and need for postoperative PRP.
“This is not a randomized controlled study,” Schaal said. “This is just a review of all the patients who underwent vitrectomy surgery for vitreous hemorrhage because of diabetic retinopathy. The main downside of this study is that we didn’t have a group that didn’t have vitrectomy. In other words, people who had just bleeding and the bleeding resolved and they never had surgery.”
Results
The AUC was significantly greater in the delayed vitrectomy group (276.1 logMAR*time) than in the immediate vitrectomy group (165.7 logMAR*time) (P < .0001).
“The most important finding of this study is that if you delay vitrectomy, then people are significantly visually disabled because of that. After you do a vitrectomy, there is no significant difference between the groups because everybody underwent vitrectomy,” Schaal said.
Nine of 17 eyes (52.9%) in the immediate group and 21 of 29 eyes (72.4%) in the delayed group underwent PRP before vitrectomy. Three of 17 eyes (17.6%) in the immediate group and one of 29 eyes (3.2%) in the delayed group underwent PRP after vitrectomy.
Preoperative logMAR visual acuity was 1.86 in the immediate group and 1.71 in the delayed group. Postoperative logMAR visual acuity at 6 months or final follow-up was 0.35 in the immediate group and 0.31 in the delayed group; the improvement was statistically significant in both groups (P = .002 and P < .0001, respectively).
Patients did not have any vitrectomy-related complications.
“We didn’t have retinal detachments. We didn’t have endophthalmitis. We didn’t have hypotony. All these are vitrectomy-related complications that we didn’t find in our study, so it was a relatively safe procedure,” Schaal said.
The overall cost for repeated visits while awaiting clearance of vitreous hemorrhage was 7.43 times greater for the delayed group than for the immediate group.
“All these clinic visits where we treat the patient with lasers or with injections are expensive,” Schaal said. “Sometimes vitrectomy is the definitive treatment. You just do a vitrectomy, and that’s it. You don’t need to repeat the treatment. So, even though vitrectomy is considered to be an invasive procedure and an expensive procedure, if you calculated the total cost, it would be cheaper than just having the patients come back and come back.” – by Matt Hasson
- Reference:
- Fassbender JM, et al. Ophthalmic Surg Lasers Imaging Retina. 2016;doi:10.3928/23258160-20151214-05.
- For more information:
- Shlomit Schaal, MD, PhD, can be reached at Department of Ophthalmology & Visual Sciences, University of Louisville, 301 E. Muhammad Ali Blvd., Louisville, KY 40202; email: s.schaal@louisville.edu.
Disclosure: Schaal reports no relevant financial disclosures.