The Diabetic Retinopathy Vitrectomy Study (DRVS) addressed the timing of vitrectomy for severe non-clearing vitreous haemorrhage. Which subgroup derived the greatest benefit from EARLY vitrectomy performed within 6 months of the haemorrhage?

• A Type 2 diabetics older than 60 years who had completed panretinal photocoagulation
• B Patients with attached retina on B-scan regardless of diabetes type
• C All patients with bilateral haemorrhage irrespective of laser status
• D Type 1 diabetics younger than 40 years who had NOT received previous panretinal photocoagulation ✓

Explanation

The DRVS randomised eyes with severe vitreous haemorrhage to early vitrectomy versus conventional management. Early surgery improved the chance of achieving useful vision overall, but the benefit was concentrated in type 1 diabetics under 40 years, particularly those without prior panretinal photocoagulation, whose fibrovascular proliferation progresses aggressively. Older type 2 patients with completed PRP did well with deferred surgery once the fellow-eye strategy allowed spontaneous clearance.

Reference: Ryan's Retina, 6th ed.

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