Abstract
BACKGROUND: Postoperative vitreous hemorrhage (POVH) after pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) is a common complication that delays visual recovery. While vitreous lavage (VL) mechanically clears hemorrhages, intravitreal ranibizumab (IVR) targets VEGF-mediated neovascularization. We compared the efficacy and safety of IVR and VL for the management of POVH. OBJECTIVE: To compare the visual outcomes, hemorrhage clearance efficiency, and complications between IVR and VL over a 24-week follow-up period. METHODS: In this prospective randomized controlled trial, 26 patients with POVH for PDR were allocated to the VL (n=12) or IVR (n=14) groups. Follow-up evaluations at 1 day, 1 week, 2 weeks, and monthly for up to 6 months included best-corrected visual acuity (BCVA) and complications. Novel metrics that included Visual Acuity Recovery Rate (VARR), Time to 1.0 logMAR-Equivalent Improvement (T1EI), and time to peak BCVA (T(peak VA)) quantified the recovery dynamics. RESULTS: At 24 weeks, BCVA improvement was comparable between groups (VL: 0.30 LogMAR vs IVR: 0.22 LogMAR, p=0.47). VL achieved immediate BCVA gains in one day (1.99 vs 0.91 LogMAR, p<0.01), whereas IVR demonstrated progressive improvement after 2 weeks. VARR was higher in VL at 1 day (0.76 vs 0.25, p<0.001) and 2 weeks (0.84 vs 0.61, p=0.06) but converged by 24 weeks (p=0.86). The complication rates (recurrent hemorrhage and neovascular glaucoma) were similar (p>0.05). CONCLUSION: VL and IVR were both associated with improved visual outcomes in patients with POVH throughout the 24-week follow-up period. The VL group achieved immediate BCVA improvement, and IVR showed a progressive improvement pattern. The VL group showed superior short-term efficiency. IVR showed a trend towards sustained recovery over the 24-week study period. In our study, IVR showed a trend of higher recovery efficiency within the follow-up timeframe. The advert treatment outcomes after the two treatments did not significantly differ. Thus, treatment selection should balance the urgency of visual rehabilitation and patient-specific factors.