A 65-year-old diabetic with proliferative diabetic retinopathy (PDR) develops a sudden, dense vitreous hemorrhage obscuring the fundus. B-scan ultrasonography shows no retinal detachment. According to current evidence-based guidelines (DRS/ETDRS), the MOST appropriate next step is:
- A Immediate panretinal photocoagulation (PRP) through the hemorrhage
- B Intravitreal anti-VEGF injection and observe for 4-6 weeks ✓
- C Pars plana vitrectomy within 48 hours
- D Observe for spontaneous clearance and arrange for PRP when hemorrhage clears
Correct answer: B. Intravitreal anti-VEGF injection and observe for 4-6 weeks
Explanation
Current guidelines recommend intravitreal anti-VEGF (bevacizumab/ranibizumab) as initial therapy for vitreous hemorrhage from PDR, which can reduce neovascularization and facilitate faster clearing while avoiding emergent vitrectomy risk. If hemorrhage does not clear within 4-6 weeks, pars plana vitrectomy is indicated. The DRS established PRP as definitive treatment for PDR, but PRP through dense hemorrhage is technically not feasible. Early vitrectomy is reserved for tractional/combined detachment.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.