Early Versus Delayed Vitrectomy for Vitreous Hemorrhage Secondary to Proliferative Diabetic Retinopathy

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2024-10-28 DOI:10.1016/j.ajo.2024.10.019

Rodrigo Anguita , Lorenzo Ferro Desideri , Philipp Schwember , Neil Shah , Syed Ahmed , Antony Raharja , Janice Roth , Sobha Sivaprasad , Louisa Wickham

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引用次数: 0

Abstract

Objective

To compare the clinical outcomes of early pars plana vitrectomy (PPV) versus delayed PPV in patients with first episode of vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR).

Design

Retrospective, comparative, interventional study.

Subjects, Participants, and/or Controls

Consecutive patients with type 1 or II diabetes diagnosed with new onset VH secondary to PDR who underwent PPV at Moorfields Eye Hospital between December 2014 and December 2016. Exclusions were prior vitrectomy, iris neovascularization, neovascular glaucoma, macular edema, or presence of tractional/rhegmatogenous retinal detachment.

Methods, Intervention, or Testing

Patients were divided into two groups based on the timing of their surgery: early PPV (≤6 weeks) and delayed PPV (>6 weeks). Demographic and clinical features, including best-corrected visual acuity (BCVA), expressed in logMAR at baseline and 12 months were collected. Statistical analyses, including propensity score matching, were performed using Python 3.10, Scikit-learn, Pandas, and GraphPad Prism 10.

Main Outcome Measures

BCVA at 12 months postoperatively, reoperation rates, and severity of complications.

Results

A total of 178 eyes were analyzed (48 early PPV, 130 delayed PPV). The mean (SD) number of weeks before surgery was 3.36 (SD 1.6) for the early PPV group and 22.56 (SD 17.23) for the delayed PPV group (P < .0001). Baseline BCVA prior to PPV was similar between groups (P = .08). At 12 months, the early PPV group had significantly better BCVA (0.40 logMAR vs 0.67 logMAR; P = .02). Patients without evidence of posterior vitreous detachment on ultrasound or OCT showed more pronounced differences (0.3 logMAR vs 0.7 logMAR; P = .001). The early PPV group had fewer sight-threatening complications (P = .005). Multivariable logistic regression identified initial BCVA, early PPV, and absence of preoperative panretinal photocoagulation as significant predictors of better visual outcomes.

Conclusions

Early PPV significantly improves visual outcomes and reduces severe complications in patients with VH secondary to PDR. These findings support the benefits of early surgical intervention to enhance long-term visual prognosis in these patients. However, a randomized clinical trial is warranted.

查看原文本刊更多论文

增生性糖尿病视网膜病变继发玻璃体出血的早期与延迟玻璃体切除术。

目的比较早期玻璃体旁切除术（PPV）与延迟PPV对增殖性糖尿病视网膜病变（PDR）继发首次玻璃体出血（VH）患者的临床疗效：研究对象、参与者和/或对照组：2014年12月至2016年12月期间在Moorfields眼科医院接受PPV治疗的新发VH继发于PDR的1型或II型糖尿病连续患者。方法、干预或检测：根据手术时间将患者分为两组：早期PPV（≤6周）和延迟PPV（>6周）。收集基线和 12 个月时的人口统计学和临床特征，包括以 LogMAR 表示的最佳矫正视力（BCVA）。使用 Python 3.10、Scikit-learn、Pandas 和 GraphPad Prism® 10 进行统计分析，包括倾向得分匹配：主要结果指标：术后 12 个月的 BCVA、再次手术率和并发症严重程度：结果：共分析了 178 只眼睛（48 只早期 PPV，130 只延迟 PPV）。早期 PPV 组的术前平均周数为 3.36 周（标清 1.6 周），延迟 PPV 组的术前平均周数为 22.56 周（标清 17.23 周）：对于继发于PDR的VH患者，早期PPV能明显改善视觉效果并减少严重并发症。这些研究结果支持早期手术干预对改善这些患者的长期视觉预后的益处。不过，还需要进行随机临床试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.