Outcomes and Complications of Pars Plana Vitrectomy for Nonclearing Vitreous Hemorrhage Without Tractional Elements

Summary

PPV for non-clearing diabetic vit heme without traction. Preop anti-VEGF does not affect postop vitreous heme, VA, or repeat PPV— retrospective, 306 eyes.

Abstract

Objective: To evaluate outcomes and complications of pars plana vitrectomy (PPV) for nonclearing vitreous hemorrhage (NCVH) secondary to proliferative diabetic retinopathy (DR) in the small-gauge, anti-VEGF era.

Design: Retrospective consecutive case series of patients seen at Cole Eye Institute from 2014 to 2022 SUBJECTS: Three hundred and six eyes undergoing PPV for NCVH.

Methods: Key inclusion criteria included PPV specifically indicated for NCVH without tractional retinal detachment secondary to the diagnosis of DR of any severity. Patients without preoperative documentation or 6- and 12-month follow-up visits were excluded. Pertinent data were then manually extracted from the electronic medical record. Descriptive statistics, univariate analysis, and propensity score-matched regression analysis were performed.

Main outcome measures: Postoperative vitreous hemorrhage (POVH), repeated vitrectomy, and best-corrected visual acuity (BCVA) at 12 months.

Results: Anti-VEGF was used in 199 of 306 eyes (65.0%) preoperatively with an average number of 1.67 ± 0.8 injections before vitrectomy. At 12 months after surgery, 94.8% of patients gained or maintained their BCVA. Seventy-five of 306 patients (24.5%) had a POVH, with only 48 of 306 patients (15.6%) requiring a second vitrectomy. Preoperative anti-VEGF injections were not associated with reduced odds of recurrent vitreous hemorrhage, improved 12-month BCVA, nor did they protect against repeat vitrectomy.

Conclusions: This study did not find evidence that preoperative anti-VEGF provided significant benefit in visual rehabilitation, reoperation, or overall POVH in NCVH cases without preoperative evidence of tractional detachment.