Diabetic Retinopathy Vitrectomy Study (DRVS)

Diabetic Retinopathy Vitrectomy Study (DRVS)

STUDY QUESTION:

Is early vitrectomy preferable to delayed vitrectomy in eyes with severe vitreous hemorrhage from PDR?

Is early vitrectomy preferable to delayed vitrectomy in eyes with PDR without vitreous hemorrhage?

STUDY POPULATION:

Patients with advanced active PDR with VA of 10/200 or better, or patients with recent vitreous hemorrhage from PDR causing reduction in VA to 5/200 or less for at least 1 month.

Patients were excluded who had previous vitrectomy, photocoagulation within previous 3 months, IOP > 29 on meds, severe NVI, or NVG.

STUDY DESIGN:

This was a randomized, prospective multicenter clinical trial.

Patients were randomized to early vitrectomy (1 to 6 months) or delayed vitrectomy (after at least 12 months).

The primary outcome measure was visual acuity.

STUDY GROUPS:

Group N:              Natural history study with 744 eyes enrolled.

Group NR:              Evaluated early vitrectomy vs. delayed vitrectomy in eyes with advanced PDR without severe vision loss (VA > 10/200).  370 eyes enrolled.

Group H:             Evaluated early vitrectomy vs. delayed vitrectomy in eyes with PDR and history of sudden visual loss from severe vitreous hemorrhage within 6 months (VA < 5/200, but not NLP).  616 eyes enrolled.

STUDY GROUP OUTCOMES:

Group NR 4-year results:

  • Patients in the early vitrectomy group had better visual outcomes than those in the delayed vitrectomy group.
  • Patients with type 1 DM had better visual outcomes with early vitrectomy than with delayed vitrectomy.
  • Previous PRP increased chances of good vision.
  • With increasing severity of NV, early vitrectomy was better than delayed vitrectomy.

Group H 2-year results:

  • Patients with type 1 DM had better visual outcomes with early vitrectomy than with delayed vitrectomy.
  • No advantage was seen with early vitrectomy in patients with type 2 DM.

RESULTS:

Eyes undergoing early vitrectomy were more likely to have VA ≥ 20/200 at 3 months.

Eyes undergoing early vitrectomy were more likely to have VA ≥ 20/40 at 2 years.

Better anatomic results were seen with early vitrectomy.

The greatest long-term benefit of early vitrectomy was seen in patients with type 1 DM.

The benefits of early vitrectomy increased with increasing severity of NV.

NLP was observed in 20% of eyes after vitreous hemorrhage regardless of intervention.

CONCLUSIONS:

Early vitrectomy is recommended for eyes with severe vision loss from non-clearing VH of at least 1 month’s duration in patients with type 1 DM, or in monocular patients regardless of the type of diabetes.

Early vitrectomy is also recommended for eyes with advanced active PDR, particularly when extensive NV is present.