For patients with proliferative diabetic retinopathy (PDR), a complication such as vitreous hemorrhage can mean vision loss. The traditional approach to this complication centers on the use of panretinal photocoagulation after waiting for spontaneous clearance during an observation period. If spontaneous clearance doesn’t occur after a three-month period, vitrectomy is often the next step. While backed by the literature, this approach leads to delays in treatment and allows for potential progression of underlying retinal pathology, according to the authors of a paper recently published in American Journal of Ophthalmology. “With advancements in surgical techniques, early pars plana vitrectomy (PPV) is emerging as an alternative option for vitreous hemorrhage to enable faster visual rehabilitation,” they wrote. Their findings showed that early PPV results in better outcomes.

Despite adequate laser treatment, many PDR eyes still experience complications such as persistent neovascularization, recurrent vitreous hemorrhage and tractional retinal detachment. Photo: Carolyn Majcher, OD. Click image to enlarge.

The researchers analyzed 178 eyes with first-episode vitreous hemorrhage that underwent PPV. They divided patients into two groups by surgical timing—an early PPV group (≤6 weeks) consisting of 48 eyes and a delayed PPV group (>6 weeks) of 130 eyes. The early PPV group went an average of 3.36 weeks before surgery, compared with 22.56 weeks for the delayed group, a significant difference. Both groups had similar baseline vision before PPV.

One year later, the group that underwent early PPV had significantly better BCVA (0.4 vs. 0.67 logMAR), the researchers reported. Those without posterior vitreous detachment on ultrasound or OCT had greater visual acuity differences (0.3 vs. 0.7 logMAR). The early PPV group also had fewer sight-threatening complications.

According to multivariable logistic regression, initial BCVA, early PPV and lack of preoperative panretinal photocoagulation were significant predictors for better visual outcomes, the researchers reported.

“Early PPV significantly improves visual outcomes and reduces severe complications in patients with vitreous hemorrhage secondary to PDR,” the researchers concluded in their American Journal of Ophthalmology paper. “These findings support the benefits of early surgical intervention to enhance long-term visual prognosis in these patients…However, these findings should be investigated in a prospective randomized trial so that robust evidence can be generated to enable change of practice.”