A COMPARATIVE STUDY BETWEEN EARLY VERSUS DEFERRED VITRECTOMY IN MANAGEMENT OF UNCOMPLICATED DIABETIC VITREOUS HAEMORRHAGE

Abstract

Objective: To determine the visual outcome and frequency of complications after pars planavitrectomy in cases of diabetic vitreous hemorrhage underwent early (within one month ofonset) versus delayed vitrectomy (after one month of onset). Patients and Methods: Thirtyeyes of 30 diabetic patients presented by uncomplicated diabetic vitreous haemorrhage divided intotwo groups; each group consists of fifteen eyes. Group Aincluded the patients presented bydiabetic vitreous haemorrhage and undergone early vitrectomy within one month of onset.Group B included the patients presented by diabetic vitreous haemorrhage after one month ofonset and undergone delayed vitrectomy after one month of onset. Results: In group A, we foundpostoperative visual acuity ranges from 6/60 to 6/12 (1.00 to 0.30 Log MAR) with mean 0.58 (LogMAR). In group B postoperative visual acuity ranges from 3/60 to 6/18 (1.30 to 0.48 Log MAR) withmean 0.75 (Log MAR). Patients of type I DM underwent early vitrectomy have 0.62 (Log MAR)final mean BCVA, while those underwent delayed vitrectomy have 0.75 (Log MAR) final meanBCVA. P-value (0.04) shows statistical significance among both groups. Patients of type II DMunderwent early vitrectomy have 0.56 (Log MAR) final mean BCVA, while those underwent delayedvitrectomy have 0.75 (Log MAR) final mean BCVA, P-value (0.42) shows statistical significance. Themean first day IOP was 19.13 mmHg in group A vs 17.8 mmHg in group B. No patients in group A had a first day IOP recorded above 23 mmHg. In group B, however, two patients had a 1st dayIOP above 23 mmHg and required a short course of oral acetazolamide and topical antiglaucomamedications. In contrast, three patients had postoperative hypotony (IOP<10mmHg) in group Acompared to one patient in group B. However, at the 1st week follow-up appointment all IOPs had returnedto within normal limits. P-value (0.364) shows no statistical significance among both groupsConclusion: Visual results after PPV in diabetic vitreous hemorrhage show that most of patients regainor retain useful vision. Early vitrectomy with endolaser retinal photocoagulation for diabetic vitreoushaemorrhage (<30 days) decreases time spent with vision loss and the need for adjunctive PRPespecially in patients of type I DM, recurrent vitreous haemorrhage and cases of premacular subhyaloidhaem-orrhage. A few proportions of patients may develop late complications like recurrentvitreous hemorrhage and retinal detachment after successful PPV requiring secondaryintervention.