A diabetic patient with proliferative diabetic retinopathy develops a dense vitreous haemorrhage that fails to clear over 3 months. B-scan ultrasonography reveals vitreous haemorrhage with posterior hyaloid detachment and no retinal detachment. What is the appropriate management?
- A Pars plana vitrectomy (PPV) with PRP under direct visualisation ✓
- B Continue observation for another 3 months with repeat B-scan
- C Perform PRP through the haemorrhage using indirect laser
- D Intravitreal anti-VEGF as the definitive treatment
Explanation
Non-clearing vitreous haemorrhage (VH) in PDR after 3 months is an indication for pars plana vitrectomy. PPV removes the blood, clears the visual axis, and — crucially — allows direct visualisation of the retina for comprehensive PRP photocoagulation which could not be delivered through opaque media. The DRVS trial established that earlier vitrectomy improves visual outcomes in dense VH in type 1 diabetics. Observation for another 3 months is inappropriate given the risk of tractional retinal detachment development. PRP through the haemorrhage is technically very limited. Anti-VEGF injections may help resorb VH (recent evidence) but are adjunctive, not definitive surgery replacements when haemorrhage is dense and persistent.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.