A 28-year-old man with type 1 diabetes of 18 years presents with a dense, non-clearing vitreous hemorrhage in his only seeing eye. B-scan shows no tractional detachment and attached retina. He has documented high-risk proliferative changes before the hemorrhage. According to the Diabetic Retinopathy Study, what is the appropriate timing of vitrectomy?

• A Observe for spontaneous clearance up to 12 months
• B Immediate lensectomy combined with silicone oil injection
• C Vitrectomy only after 6 months of documented non-clearing hemorrhage
• D Early vitrectomy within 1 month, especially if visual acuity is 5/60 or worse ✓

Explanation

The DRS showed that early vitrectomy benefits eyes with severe proliferative disease and non-clearing vitreous hemorrhage, and the benefit was greatest in type 1 diabetics, where intervention within 1 month improved the chance of good final vision. In type 2 diabetes the same benefit was not demonstrated, so conventional practice allows 3 months of observation there. Observation for 12 months risks organization of hemorrhage and progressive traction in a young patient.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.