A patient develops vitreous haemorrhage one month after intravitreal bevacizumab injection for PDR. OCT shows no tractional detachment. The appropriate next management step is:
- A Observation for 4–6 weeks for spontaneous clearance, then consider vitrectomy if no improvement ✓
- B Immediate pars plana vitrectomy
- C Immediate repeat intravitreal bevacizumab
- D Aspirin and systemic haemostatics
Correct answer: A. Observation for 4–6 weeks for spontaneous clearance, then consider vitrectomy if no improvement
Explanation
Non-clearing vitreous haemorrhage without TRD is initially observed for 4–6 weeks as many clear spontaneously, particularly in phakic eyes. If haemorrhage persists beyond 4–6 weeks (or sooner in pseudophakic eyes or if TRD is suspected), pars plana vitrectomy is indicated. Bevacizumab is used pre-operatively to involute neovascularisation before planned vitrectomy, not as acute haemorrhage treatment. Systemic haemostatics have no role.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.