Early versus Late Pars Plana Vitrectomy in Vitreous Hemorrhage: A Systematic Review

Abstract

Background: Vitreous hemorrhage (VH) is a common vitreoretinal condition causing impairment of vision due to various etiologies. No consensus exists on the best timing for performing pars plana vitrectomy (PPV) in fundus-obscuring VH. Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, we conducted a systematic review of the timing of PPV in VH. We assessed the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for all the included publications, in accordance with the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) recommendations. Results: A total of 1731 articles were identified. Following the removal of duplicates and screening of abstracts, 1203 articles remained. Subsequently, a comprehensive full-text review of 30 articles was conducted. Ultimately, 18 articles met the predefined inclusion criteria. Conclusions: Despite the small number of studies on the timing of treatment for VH, the advantage of early over late PPV seems to be a reasonable approach in selected cases, and it might be considered modern standard care.

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“…Vitrectomy is the final stage of treatment performed when non-resolving vitreous hemorrhages last for longer than 3 months [ 21 ]. Although typically considered a last resort, earlier vitrectomy prompted by early posterior vitreous detachment allows surgeons to achieve safe surgery with satisfactory results [ 21 , 43 ]. Notably, studies have demonstrated a high success rate of vitrectomy in improving the visual acuity of patients with vitreous hemorrhage or tractional retinal detachment [ 44 ].…”