{"id":727,"date":"2010-12-08T13:02:50","date_gmt":"2010-12-08T18:02:50","guid":{"rendered":"http:\/\/www.bu.edu\/?page_id=727"},"modified":"2011-11-21T09:31:14","modified_gmt":"2011-11-21T14:31:14","slug":"diabetic-retinopathy-vitrectomy-study-drvs","status":"publish","type":"page","link":"https:\/\/www.bu.edu\/eye\/evidence-based-medicine\/vitreo-retinal-studies\/diabetic-retinopathy-vitrectomy-study-drvs\/","title":{"rendered":"Diabetic Retinopathy Vitrectomy Study (DRVS)"},"content":{"rendered":"<p><strong>Diabetic Retinopathy Vitrectomy Study (DRVS)<\/strong><\/p>\n<p>STUDY QUESTION:<\/p>\n<p>Is early vitrectomy preferable to delayed vitrectomy in eyes with severe vitreous hemorrhage from PDR?<\/p>\n<p>Is early vitrectomy preferable to delayed vitrectomy in eyes with PDR <em>without<\/em> vitreous hemorrhage?<\/p>\n<p>STUDY POPULATION:<\/p>\n<p>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.<\/p>\n<p>Patients were excluded who had previous vitrectomy, photocoagulation within previous 3 months, IOP &gt; 29 on meds, severe NVI, or NVG.<\/p>\n<p>STUDY DESIGN:<\/p>\n<p>This was a randomized, prospective multicenter clinical trial.<\/p>\n<p>Patients were randomized to early vitrectomy (1 to 6 months) or delayed vitrectomy (after at least 12 months).<\/p>\n<p>The primary outcome measure was visual acuity.<\/p>\n<p>STUDY GROUPS:<\/p>\n<p>Group N:\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Natural history study with 744 eyes enrolled.<\/p>\n<p>Group NR:\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Evaluated early vitrectomy vs. delayed vitrectomy in eyes with advanced PDR without severe vision loss (VA &gt; 10\/200).\u00a0 370 eyes enrolled.<\/p>\n<p>Group H: \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Evaluated early vitrectomy vs. delayed vitrectomy in eyes with PDR and history of sudden visual loss from severe vitreous hemorrhage within 6 months (VA &lt; 5\/200, but not NLP).\u00a0 616 eyes enrolled.<\/p>\n<p>STUDY GROUP OUTCOMES:<\/p>\n<p>Group NR 4-year results:<\/p>\n<ul>\n<li>Patients in the early vitrectomy group had better visual outcomes than those in the delayed vitrectomy group.<\/li>\n<li>Patients with type 1 DM had better visual outcomes with early vitrectomy than with delayed vitrectomy.<\/li>\n<li>Previous PRP increased chances of good vision.<\/li>\n<li>With increasing severity of NV, early vitrectomy was better than delayed vitrectomy.<\/li>\n<\/ul>\n<p>Group H 2-year results:<\/p>\n<ul>\n<li>Patients with type 1 DM had better visual outcomes with early vitrectomy than with delayed vitrectomy.<\/li>\n<li>No advantage was seen with early vitrectomy in patients with type 2 DM.<\/li>\n<\/ul>\n<p>RESULTS:<\/p>\n<p>Eyes undergoing early vitrectomy were more likely to have VA \u2265 20\/200 at 3 months.<\/p>\n<p>Eyes undergoing early vitrectomy were more likely to have VA \u2265 20\/40 at 2 years.<\/p>\n<p>Better anatomic results were seen with early vitrectomy.<\/p>\n<p>The greatest long-term benefit of early vitrectomy was seen in patients with type 1 DM.<\/p>\n<p>The benefits of early vitrectomy increased with increasing severity of NV.<\/p>\n<p>NLP was observed in 20% of eyes after vitreous hemorrhage regardless of intervention.<\/p>\n<p>CONCLUSIONS:<\/p>\n<p>Early vitrectomy is recommended for eyes with severe vision loss from non-clearing VH of at least 1 month\u2019s duration in patients with type 1 DM, or in monocular patients regardless of the type of diabetes.<\/p>\n<p>Early vitrectomy is also recommended for eyes with advanced active PDR, particularly when extensive NV is present.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":1980,"featured_media":0,"parent":698,"menu_order":4,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/727"}],"collection":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/users\/1980"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/comments?post=727"}],"version-history":[{"count":5,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/727\/revisions"}],"predecessor-version":[{"id":972,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/727\/revisions\/972"}],"up":[{"embeddable":true,"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/pages\/698"}],"wp:attachment":[{"href":"https:\/\/www.bu.edu\/eye\/wp-json\/wp\/v2\/media?parent=727"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}