Abstract
We compared outcomes of four different management modalities for diabetic VH. Patients with diabetic VH were identified in this retrospective study undertaken at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Eyes were grouped based on the treatment received: control (observation only), intravitreal bevacizumab (IVB) injection(s), pars plana vitrectomy (PPV), and preoperative single IVB injection before PPV. Best-corrected visual acuity (BCVA) and status of VH were noted at baseline and the last follow up (Minimum: 6 months, maximum: 29 months). The proportion of eyes with Snellen BCVA improvement by two lines or more and VH clearance at the last follow up were compared between groups. The four groups – Control, IVB, PPV, and IVB-before-PPV had 23, 29, 17, and 20 eyes, respectively. The proportion of eyes gaining ≥2 lines was substantially higher in the IVB-before-PPV and PPV groups (90% and 77%, respectively) compared with IVB and observation groups (41% and 22%, respectively). Surgical treatment was associated with a 2.38 times higher likelihood of gaining ≥2 lines than the non-surgical one (incidence ratio: 2.38, 95% CI 1.19, 4.78 P = 0.015) after adjusting for age, hyperglycemia and BCVA at presentation. Less invasive treatment such as IVB injections did not result in the same amount of improvement in vision as did PPV. Prospective randomized studies are needed to better define the role of IVB injections in the management of diabetic VH.
Highlights
We compared outcomes of four different management modalities for diabetic vitreous hemorrhage (VH)
The proportion of eyes gaining ≥2 lines was the highest in the preoperative intravitreal bevacizumab (IVB)-before-pars plana vitrectomy (PPV) group followed by PPV
For PPV and preoperative IVB-before-PPV groups compared with control, the age, hyperglycemia and Best-corrected visual acuity (BCVA) adjusted incidence ratios for VA gain of ≥2 lines were 3.31(95% CI, 1.03, 10.62; P = 0.044) and 3.79(95% CI, 1.26, 11.43; P = 0.018), respectively
Summary
We compared outcomes of four different management modalities for diabetic VH. Patients with diabetic VH were identified in this retrospective study undertaken at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Surgical treatment was associated with a 2.38 times higher likelihood of gaining ≥2 lines than the non-surgical one (incidence ratio: 2.38, 95% CI 1.19, 4.78 P = 0.015) after adjusting for age, hyperglycemia and BCVA at presentation. Less invasive treatment such as IVB injections did not result in the same amount of improvement in vision as did PPV. Www.nature.com/scientificreports they concluded most patients may be managed non-surgically[10] Another recent study by Chelala et al demonstrated intravitreal ranibizumab injections were effective in mild-moderate VH in diabetic patients[11]
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