A comparison of immediate and delayed vitrectomy for the management of vitreous hemorrhage due to proliferative diabetic retinopathy

BACKGROUND AND OBJECTIVE: To compare immediate and delayed vitrectomy for the management of vitreous hemorrhage (VH) due to proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Retrospective review of 134 eyes receiving vitrectomy for non-clearing, PDR-associated VH. Primary outcome was area under the vision curve (AUC) in patients receiving immediate (< 30 days) versus delayed (> 30 days) vitrectomy with endolaser. RESULTS: Forty-six eyes were included, with 17 undergoing immediate (< 30 days) vitrectomy with endolaser and 29 undergoing delayed (> 30 days) vitrectomy with endolaser. Time to vitrectomy was 14.8 days ± 8.26 days compared to 629.6 days ± 894.9 days in the immediate and delayed groups, respectively. AUC was significantly greater for patients undergoing delayed versus immediate vitrectomy (276.1 ± 0.601 logMAR^∗ time versus 165.7 ± 0.761 logMAR^∗ time; P <.0001). There was no difference in AUC postoperatively for delayed versus immediate surgery. Both groups required significantly less postoperative panretinal photocoagulation (P <.05). Preoperative and final visual acuities were equivalent (immediate: 1.86 ± 0.99 and 0.35 ± 0.25; P =.002; delayed: 1.71 ± 1.05 and 0.31 ± 0.34; P <.0001). CONCLUSIONS: Immediate vitrectomy with endolaser for PDR-associated VH (< 30 days) decreases time spent with vision loss and the need for adjunctive PRP. Modern vitrectomy is safe and may be considered earlier in VH management.