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Miguel A Quiroz-Reyes,1 Erick Andrés Quiroz-Gonzalez,1,2 Miguel A Quiroz-Gonzalez,1 Virgilio Lima-Gómez3 1Retina Department, Oftalmologia Integral ABC, Mexico City, Mexico; 2Ophthalmology Department, Institute of Ophthalmology, Mexico City, Mexico; 3Retina Department, Juarez Hospital, Mexico City, MexicoCorrespondence: Miguel A Quiroz-Reyes, Retina Department, Oftalmologia Integral ABC, Paseo de las Palmas 735 suite 303, Lomas de Chapultepec, Mexico City, 11000, Mexico, Tel +525 5217 2732, Fax +525 55 1664 7190 ; +525 55 1664 7180, Email drquiroz@prodigy.net.mxAbstract: This review aimed to systematically compare the efficacy and safety of intravitreal aflibercept (IVA) and vitrectomy for treating severe vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). The review was conducted in accordance with PRISMA guidelines. A search strategy, including the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US National Library of Medicine databases, was developed to identify randomized controlled trials (RCTs) that compared vitrectomy and IVA for managing VH due to PDR (participant age ≥ 18 years). The primary outcome measure was the difference in the mean visual acuity between the two treatment groups at 1, 6, and 24 months. Outcome measures included clearance of VH (in weeks), the incidence of recurrent VH, and the rate of complications. The studies were evaluated using the Cochrane Bias (ROB) tool. We identified 774 articles; six articles met the inclusion criteria, and two were ultimately included (n = 239 eyes). With or without PRP, IVA injections and vitrectomy were performed in 117 and 122 eyes, respectively. The mean BCVA at one month was significantly better in the vitrectomy group (MD=0.22, CI:0.10– 0.34, p=0.0003), but no difference was found at six months (MD=0.04, CI: − 0.04– 0.12, p=0.356). The incidence of recurrent VH was significantly higher in the IVA group (OR=5.05, CI:2.71– 9.42, p< 0.0001). The probability of recurrent VH was five times greater in the IVA group than that in the vitrectomy group. There were no significant differences in the overall proportions of intra- or postoperative complications (OR=0.64, CI: 0.09– 4.85, p=0.669). None of the studies had a low ROB in any of the seven domains. We conclude that IVA can be considered a viable treatment modality for diabetic VH in patients with a good follow-up. Vitrectomy initially provides better visual effect, faster VH recovery, and lower VH recurrence than IVA injections.Keywords: aflibercept, anti-VEGF, intravitreal injection, proliferative diabetic retinopathy, vitrectomy |
