Immediate Vs Delayed Vitrectomy for The Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy

Vina Karina Apriyani, Grimaldi Ihsan, Rova Virgana, Iwan Sovani


Introduction: Surgical approach in vitreous hemorrhage (VH) secondary to diabetic retinopathy remains the procedure of choice for non-clearing VH. However, the most appropriate timing of vitrectomy is yet to be defined. With improvements in surgical techniques, it is reasonable to operate on such patients that have no spontaneous improvement.

Objective: To compare the characteristics between groups of patients who underwent immediate and delayed vitrectomy for the management of vitreous hemorrhage due to proliferative diabetic retinopathy (PDR).

Methods: Retrospective review of 35 patients who underwent vitrectomy for VH secondary to PDR. Patients were excluded if they had prior vitrectomy, follow up < 1 month post-operatively, other retinal pathology, VH secondary to other causes, uveitis, or advanced glaucoma. Primary outcome was visual acuity in patients receiving immediate (< 30 days) versus delayed (> 30 days) vitrectomy. Secondary analyses included post-surgical complications.

Results: 35 eyes were included, 13 eyes had immediate vitrectomy while 22 eyes had delayed vitrectomy. There was no difference between the groups in terms of age, gender, diabetes control, or diabetes duration. Pre-operative and final visual acuities were evaluated, including 7 days, 30-days and 3-months in both Groups. Complications within 3 months were dominantly seen in the delayed vitrectomy Group.

Conclusion: Immediate vitrectomy for VH due to PDR decreases time spent with vision loss, and decreases post-surgical complications. Modern vitrectomy surgery is safe and may be considered earlier in VH management.


1. Jaafar El Annan, Petros E. Carvounis. Current Management of Vitreous Hemorrhage due to Proliferative Diabetic Retinopathy. Int Ophthalmol Clin. 2014 Spring; 54(2):141–153.
2. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033-1046. ?
3. Sharma S, Hollands H, Brown GC, Brown MM, Shah GK, Sharma SM. The cost-effectiveness of early vitrectomy for the treatment of vitreous hemorrhage in diabetic retinopathy. Curr Opin Ophthalmol. 2001;12(3):230-234.
4. Gupta V, Arevalo JF. Surgical management of diabetic retinopathy. Middle East Afr J Ophthalmol. 2013;20(4):283-292. ??
5. Ratnarajan G, Mellington F, Saldanha M, de Silva SR, Benjamin L. Long-term visual and retinopathy outcomes in a predominately type 2 diabetic patient population undergoing early vitrectomy and endolaser for severe vitreous haemorrhage. Eye (Lond). 2011;25(6):704-708; quiz 709. ?
6. Ostri C. Intraocular surgery in a large diabetes patient population: risk factors and surgical results. Acta Ophthalmol. 2014;92 Thesis1:1-13. ??
7. Newman DK. Surgical management of the late complications of proliferative diabetic retinopathy. Eye (Lond). 2010;24(3):441-449.
8. Parikh R, Shah RJ, VanHouten JP, Cherney EF. Ocular findings at initial pan retinal photocoagulation for proliferative diabetic retinopathy predict the need for future pars plana vitrectomy. Retina. 2014;34(10):1997-2002.?
9. Gupta B, Sivaprasad S, Wong R. Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study. Eye (Lond). 2012;26(4):510-516.
10. Ushida H, Kachi S, Asami T, Ishikawa K, et al. Influence of preoperative intravitreal bevacizumab on visual function in eyes with proliferative diabetic retinopathy. Ophthalmic Res. 2013;49(1):30-36. 11. Agarwal A, Soliman MK, Sepah YJ, Do DV, Nguyen QD. Diabetic retinopathy: variations in patient therapeutic outcomes and pharmacogenomics. Pharmgenomics Pers Med. 2014;7:399-409.
12. Zhang Rui, et al. The Association of Retinopathy and Plasma Glucose and HbA1c: A Validation of Diabetes Diagnostic Criteria in a Chinese Population. Journal of Diabetes Research. 2016; 1-8.


Vina Karina Apriyani
Grimaldi Ihsan
Rova Virgana
Iwan Sovani
Apriyani, . V. K., Ihsan, G., Virgana, R., & Sovani, I. (2023). Immediate Vs Delayed Vitrectomy for The Management of Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy. Ophthalmologica Indonesiana, 48(2), 46–52.

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