Vitrectomy Alone Versus Anti-vascular Endothelial Growth Factor (Anti-VEGF) Therapy Prior to Vitrectomy for Diabetic Vitreous Hemorrhage: A Systematic Review and Meta-Analysis.

Abstract

Proliferative diabetic retinopathy (PDR) affects approximately 1.5% of adults with diabetes and is a leading cause of blindness due to complications such as vitreous hemorrhage. Pan-retinal photocoagulation (PRP) has been the mainstay of treatment for many years. Still, the advent of anti-vascular endothelial growth factor (anti-VEGF) agents, including ranibizumab, bevacizumab, and aflibercept, presents successful therapeutic options. This study aims to conduct a systematic review and meta-analysis to compare the efficacy of anti-VEGF therapy combined with vitrectomy versus vitrectomy alone in patients with vitreous hemorrhage due to diabetic retinopathy. Many electronic sources, such as PubMed and Google Scholar, were searched for pertinent literature. PICOS (population, intervention, comparison, outcomes, and study) criteria were applied to select the studies systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework was employed to synthesize and report data. The analysis included six studies with a total of 468 patients. Results indicated a significant improvement in best-corrected visual acuity (BCVA) at three months in the anti-VEGF group compared to vitrectomy alone (MD = -0.19; p = 0.02), while no significant differences were found at one month (MD = 0.08; p = 0.50) and six months (MD = 0.03; p = 0.40). Additionally, no significant differences in recurrent vitreous hemorrhage rates were observed between groups. In conclusion, anti-VEGF drugs combined with vitrectomy showed significant improvements in BCVA at three months as compared to vitrectomy alone, indicating their potential effectiveness for diabetic vitreous hemorrhages. However, the scarcity of available research emphasizes the necessity of carrying out extensive clinical trials to validate the safety and efficacy of anti-VEGF treatment as compared to alternative treatment options.