A 52-year-old type 2 diabetic presents with sudden painless loss of vision in the right eye. Fundus examination reveals extensive pre-retinal hemorrhage obscuring disc details with sheet-like blood anterior to the retina. IOP is normal. Ultrasound shows no retinal detachment. What is the MOST appropriate initial management?
- A Immediate vitrectomy within 24 hours
- B Pan-retinal photocoagulation under indirect ophthalmoscopy immediately
- C Intravitreal triamcinolone acetonide
- D Intravitreal anti-VEGF injection followed by observation for 4–6 weeks ✓
Explanation
A dense vitreous hemorrhage in proliferative diabetic retinopathy (PDR) with no tractional detachment is managed with intravitreal anti-VEGF (bevacizumab/ranibizumab) to reduce neovascularization, followed by observation for 4–6 weeks for spontaneous clearance and opportunity to perform PRP once media clears. Immediate vitrectomy is reserved for non-clearing hemorrhage (>3 months), tractional retinal detachment threatening the macula, or combined tractional–rhegmatogenous detachment. Immediate PRP cannot be performed through dense hemorrhage. Intravitreal triamcinolone is not first-line for vitreous hemorrhage in PDR.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.