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

Document Type : Original articles: include clinical trials, interventional research, Basic researches and clinically relevant laboratory investigations

Authors

1 Ophthalmology dept., Faculty of Medicine, Al-Azhar Univ., Assiut, Egyp

2 Ophthalmology dept., Faculty of Medicine, Al-Azhar Univ., Assiut, Egypt

Abstract

Objective: To determine the visual outcome and frequency of complications after pars plana
vitrectomy in cases of diabetic vitreous hemorrhage underwent early (within one month of
onset) versus delayed vitrectomy (after one month of onset). Patients and Methods: Thirty
eyes of 30 diabetic patients presented by uncomplicated diabetic vitreous haemorrhage divided into
two groups; each group consists of fifteen eyes. Group Aincluded the patients presented by
diabetic vitreous haemorrhage and undergone early vitrectomy within one month of onset.
Group B included the patients presented by diabetic vitreous haemorrhage after one month of
onset and undergone delayed vitrectomy after one month of onset. Results: In group A, we found
postoperative visual acuity ranges from 6/60 to 6/12 (1.00 to 0.30 Log MAR) with mean 0.58 (Log
MAR). In group B postoperative visual acuity ranges from 3/60 to 6/18 (1.30 to 0.48 Log MAR) with
mean 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 mean
BCVA. P-value (0.04) shows statistical significance among both groups. Patients of type II DM
underwent early vitrectomy have 0.56 (Log MAR) final mean BCVA, while those underwent delayed
vitrectomy have 0.75 (Log MAR) final mean BCVA, P-value (0.42) shows statistical significance. The
mean first day IOP was 19.13 mmHg in group A vs 17.8 mmHg in group B. No patients in group < br />A had a first day IOP recorded above 23 mmHg. In group B, however, two patients had a 1st day
IOP above 23 mmHg and required a short course of oral acetazolamide and topical antiglaucoma
medications. In contrast, three patients had postoperative hypotony (IOP<10mmHg) in group A
compared to one patient in group B. However, at the 1st week follow-up appointment all IOPs had returned
to within normal limits. P-value (0.364) shows no statistical significance among both groups
Conclusion: Visual results after PPV in diabetic vitreous hemorrhage show that most of patients regain
or retain useful vision. Early vitrectomy with endolaser retinal photocoagulation for diabetic vitreous
haemorrhage (<30 days) decreases time spent with vision loss and the need for adjunctive PRP
especially in patients of type I DM, recurrent vitreous haemorrhage and cases of premacular subhyaloid
haem-orrhage. A few proportions of patients may develop late complications like recurrent
vitreous hemorrhage and retinal detachment after successful PPV requiring secondary
intervention.

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