Abstract
BackgroundTo compare efficacy and safety of intravitreal aflibercept (IVA) injection with panretinal photocoagulation (PRP) versus early vitrectomy for diabetic vitreous hemorrhage (VH).MethodsProspective, randomized study that included 34 eyes with diabetic VH. They were divided into two groups, Group Ι (17 eyes) received three successive IVA injections followed by PRP and group ΙΙ (17 eyes) for whom early vitrectomy was done. Follow up was carried out after one, two, three, six and nine months. The primary outcome measure was change in the mean best corrected visual acuity (BCVA) after nine months, secondary outcome measures were mean duration of clearance of VH and rate of recurrent hemorrhage with any additional treatment in both groups. Complications were reported.ResultsThere was no statistically significant difference regarding initial demographic criteria between both groups. The mean final log MAR BCVA was statistically better than the initial BCVA in both groups (0.51 ± 0.20, 1.17 ± 0.48 for group I and 0.48 ± 0.18, 1.44 ± 0.44 for group II, P < 0.001). There was no statistically significant difference between both groups regarding the mean final Log Mar BCVA (0.51 ± 0.20 for group I, 0.48 ± 0.18 for group II, p ≥ 0.05), the mean duration of clearance of VH was 7.8 ± 1.8 weeks, 5 days for group I and II respectively. PRP was completely done for all eyes in group I after three months. The difference in the recurrence rate between group I (29.4%) and group II (11.8%) was statistically significant (p < 0.05). Vitrectomy was done for three eyes (17.6%) due to recurrent non-resolving VH in group I. late recurrent VH occurred in two eyes (11.8%) in group II, IVA was given with complete clearance of the hemorrhage. No vision threatening complications were reported in both groups.ConclusionBoth intravitreal injection of aflibercept followed by PRP and early vitrectomy are effective and safe modalities for treatment of diabetic vitreous hemorrhage. Early vitrectomy leads to faster vision gain with less incidence of recurrence than intravitreal injection.Trial registrationRandomized clinical trial under the number of NCT04153253 on November 6, 2019 “Retrospectively registered”.
Highlights
To compare efficacy and safety of intravitreal aflibercept (IVA) injection with panretinal photocoagulation (PRP) versus early vitrectomy for diabetic vitreous hemorrhage (VH)
In proliferative diabetic retinopathy (PDR) stage, hypoxic retinal tissue leads to liberation of angiogenic agents such as vascular endothelial growth factor (VEGF) which plays a major role in the development of retinal and optic disc neovascularization, such neo vessels can bleed at any time and cause vitreous hemorrhage (VH)
Another multicenter study compared the outcome of intravitreal ranibizumab (IVR) injections versus intravitreal saline injections in the treatment of VH in patients with PDR, and suggested that IVR increased the likelihood of completion of PRP without pars plana vitrectomy (PPV) [5]
Summary
To compare efficacy and safety of intravitreal aflibercept (IVA) injection with panretinal photocoagulation (PRP) versus early vitrectomy for diabetic vitreous hemorrhage (VH). Recent study from the diabetic retinopathy clinical research network (DRCRN) reported that intravitreal ranibizumab (IVR) is non-inferior to PRP treatment for PDR at the end of two years but the study did not address the role in VH [4]. Another multicenter study compared the outcome of IVR injections versus intravitreal saline injections in the treatment of VH in patients with PDR, and suggested that IVR increased the likelihood of completion of PRP without pars plana vitrectomy (PPV) [5]. There was a beneficial effect of intravitreal bevacizumab (IVB) for managing VH in PDR [6]
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