Comparing Treatment Strategies for Uncomplicated Diabetic Vitreous Hemorrhage: Medical Therapy versus Early Pars Plana Vitrectomy

Abstract

Purpose: Pars plana vitrectomy (PPV) is typically reserved for refractory and complicated cases of diabetic vitreous hemorrhage (VH). However, no consensus guidelines are available for uncomplicated VH treatment. This study aimed to compare outcomes of medical versus surgical treatments for uncomplicated diabetic VH. Methods: We conducted a retrospective review of medical records for patients with diabetic VH, focusing on uncomplicated cases. Patients were assigned to medical and surgical groups (early and rescue PPV). The medical group treatments included observation only, intravitreal anti-VEGF injection, and panretinal photocoagulation (PRP), with PRP completed after VH resorption in all cases. The surgical groups underwent PPV or a preoperative single intravitreal anti-VEGF before PPV. Results: There were 34 patients in the medical group and 35 in the surgical groups (24 early PPV, 11 rescue PPV). Patients in the surgical group had longer VH duration, higher VH grade, and poorer baseline CDVA compared to medical group (p<0.01 each). CDVA significantly improved in all groups post-treatment. VH clearance rates were higher in the surgical group (90%±18 for early PPV, 88%±25 for rescue PPV) compared to the medical group (70%±22, p=0.001). Final CDVA did not significantly differ between medical and surgical subgroups (p=0.549). Recurrent VH was the predominant complication in both groups. Eight surgical patients had elevated IOP, with three developing glaucoma. Rescue PPV was required in 24.4% of initially medically treated patients. Conclusion: Medical management should be the initial approach for uncomplicated diabetic VH, while PPV should be considered for cases of persistent or severe VH.