Outcomes and Complications of Pars Plana Vitrectomy for Nonclearing Vitreous Hemorrhage Without Tractional Elements

To evaluate outcomes and complications of pars plana vitrectomy (PPV) for nonclearing vitreous hemorrhage (NCVH) secondary to proliferative diabetic retinopathy (DR) in the small-gauge, anti-VEGF era.

Retrospective consecutive case series of patients seen at Cole Eye Institute from 2014 to 2022 SUBJECTS: Three hundred and six eyes undergoing PPV for NCVH.

Key inclusion criteria included PPV specifically indicated for NCVH without tractional retinal detachment secondary to the diagnosis of DR of any severity. Patients without preoperative documentation or 6- and 12-month follow-up visits were excluded. Pertinent data were then manually extracted from the electronic medical record. Descriptive statistics, univariate analysis, and propensity score-matched regression analysis were performed.

Postoperative vitreous hemorrhage (POVH), repeated vitrectomy, and best-corrected visual acuity (BCVA) at 12 months.

Anti-VEGF was used in 199 of 306 eyes (65.0%) preoperatively with an average number of 1.67 ± 0.8 injections before vitrectomy. At 12 months after surgery, 94.8% of patients gained or maintained their BCVA. Seventy-five of 306 patients (24.5%) had a POVH, with only 48 of 306 patients (15.6%) requiring a second vitrectomy. Preoperative anti-VEGF injections were not associated with reduced odds of recurrent vitreous hemorrhage, improved 12-month BCVA, nor did they protect against repeat vitrectomy.

This study did not find evidence that preoperative anti-VEGF provided significant benefit in visual rehabilitation, reoperation, or overall POVH in NCVH cases without preoperative evidence of tractional detachment.

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