Infographic: intravitreous aflibercept vs vitrectomy with panretinal photocoagulation for vitreous haemorrhage from proliferative diabetic retinopathy

Abstract Background : To investigate which demographic and clinical factors are related to the presence of recurrent vitreous haemorrhage in a population of diabetic patients diagnosed with proliferative diabetic retinopathy [PDR]. Methods: This was a retrospective review-based study. We studied 285 eyes from 165 patients with PDR. We recorded age, gender, type of diabetes mellitus [DM] , type of DM treatment, history of hypertension and body mass index, panretinal photocoagulation status and the presence of concomitant anticoagulant or antiplatelet treatment. We evaluated the mean glycosylated haemoglobin, mean haemoglobin, the urine albumin to creatinine ratio and the estimated glomerular filtration rate in each patient. In addition, we recorded the smoking history [pack-years] and the systemic complications related to DM. We used the logistic regression analysis to study which independent variables were significantly related to the presence of recurrent vitreous haemorrhage. Results: In total, 183 eyes [64%] with PDR had vitreous haemorrhage, of which 68 [37%] underwent recurrent vitreous haemorrhage. In our study, tobacco consumption [OR= 1.21, 95% CI, 1.10- 1.32, P <0.001], duration of diabetes [OR= 1.03, 95% CI, 1.0-1 .07 P = 0.04] and haemoglobin level [OR= -0.24 , 95% CI, -0.16, -0.06 , P <0 .001] had an independently significant associaton with recurrent vitreous haemorrhage. There was a positive correlation between pack-years consumed and the number of vitreous haemorrhages [r=0.339; p<0.001]. In addition, patients with diabetic polineuropathy, myocardial infarction and ischemia in lower limbs had more vitreous haemorrhage events [p<0.001]. Conclusion s : In our study, those patients with PDR who smoked, with longer duration of their diabetes, anaemia and that had previously suffered from cardiovascular events were more prone to suffer from recurrent vitreous haemorrhage.

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Intravitreal bevacizumab improves the clearance of vitreous haemorrhage and visual outcomes in patients with proliferative diabetic retinopathy

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2019-000390 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000390 ◽

Cited By ~ 1

Author(s):

Joonas Wirkkala ◽

Risto Bloigu ◽

Nina Maria Hautala

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Average Rate ◽

Real Life ◽

Intravitreal Bevacizumab ◽

Visual Outcome ◽

Vitreous Haemorrhage ◽

Panretinal Photocoagulation ◽

Kaplan Meier ◽

Real Life Data

ObjectiveTo evaluate the occurrence of vitreous haemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR) and the efficacy of intravitreal bevacizumab (IVB) for VH in 5-year real-life data.Methods and analysis850 adult patients with type 1 (T1D) or type 2 diabetes (T2D) with PDR were screened for VH. The effect of IVB was evaluated by the clearage of VH and the change in best corrected visual acuity (BCVA). The rates of VHs, reinjections, macular oedema, complications, additional treatments and outcomes of spontaneous resorption, panretinal photocoagulation or pars plana vitrectomy (PPV) for VH were also investigated.ResultsVH occurred in 16% of patients with T1D and 9% of patients with T2D with PDR. 336 VHs in 140 eyes of 103 patients were documented. VH was cleared in 92% of cases in less than 3 months by the initial IVB. IVB was superior to other treatment methods in shortening the time for clearance of VH (Kaplan-Meier, p<0.0001). The average rate of IVB reinjections was 1.7±1.1 and the reinjection interval was 7.2±3.9 weeks. BCVA increased 0.73±0.04 logarithm of the minimum angle of resolution units after IVB (generalised estimating equations, p=0.0004). In 5 years, the patients had 2.2±2.7 recurrence of VHs. A simultaneous 72% decrease in the rate of PPVs was documented (p<0.0001).ConclusionVH occurs mostly in patients with T1D. The therapeutic effect of IVB for VH was significant and led to improved clearance of VH and visual outcome. Moreover, IVB prevented persistent and recurrent VHs and decreased the need for costly PPV.

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Risk factors for recurrent vitreous haemorrhage in patients with proliferative diabetic retinopathy.

10.21203/rs.2.15191/v2 ◽

2019 ◽

Author(s):

Marc BAGET-BERNALDIZ ◽

Pere Romero-Aroca ◽

Joaquin Mercado-Gonzalez ◽

Angel Bautista-Perez ◽

Núria Soler-Lluís ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Tobacco Consumption ◽

Vitreous Haemorrhage ◽

Lower Limbs ◽

Smoking History ◽

Diabetic Patients ◽

Panretinal Photocoagulation ◽

Systemic Complications ◽

Urine Albumin

Abstract Background : To investigate which demographic and clinical factors are related to the presence of recurrent vitreous haemorrhage in a population of diabetic patients diagnosed with proliferative diabetic retinopathy [PDR]. Methods: This was a retrospective review-based study. We studied 285 eyes from 165 patients with PDR. We recorded age, gender, type of diabetes mellitus [DM] , type of DM treatment, history of hypertension and body mass index, panretinal photocoagulation status and the presence of concomitant anticoagulant or antiplatelet treatment. We evaluated the mean glycosylated haemoglobin, mean haemoglobin, the urine albumin to creatinine ratio and the estimated glomerular filtration rate in each patient. In addition, we recorded the smoking history [pack-years] and the systemic complications related to DM. We used the logistic regression analysis to study which independent variables were significantly related to the presence of recurrent vitreous haemorrhage. Results: In total, 183 eyes [64%] with PDR had vitreous haemorrhage, of which 68 [37%] underwent recurrent vitreous haemorrhage. In our study, tobacco consumption [OR= 1.21, 95% CI, 1.10- 1.32, P <0.001], duration of diabetes [OR= 1.03, 95% CI, 1.0-1 .07 P = 0.04] and haemoglobin level [OR= -0.24 , 95% CI, -0.16, -0.06 , P <0 .001] had an independently significant associaton with recurrent vitreous haemorrhage. There was a positive correlation between pack-years consumed and the number of vitreous haemorrhages [r=0.339; p<0.001]. In addition, patients with diabetic polineuropathy, myocardial infarction and ischemia in lower limbs had more vitreous haemorrhage events [p<0.001]. Conclusion s : In our study, those patients with PDR who smoked, with longer duration of their diabetes, anaemia and that had previously suffered from cardiovascular events were more prone to suffer from recurrent vitreous haemorrhage.

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