Intravitreal Ranibizumab versus Vitreous Lavage for Postoperative Vitreous Hemorrhage in Proliferative Diabetic Retinopathy: A Randomized Controlled Trial

Jiaxing Chi,1,* Xiang Zhang,1,* Zetong Nie,1 Yue Pan,1 Wenbo Li,1 Bojie Hu2 1Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China; 2NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bojie Hu, Email bhu07@tmu.edu.cn Wenbo Li, Email wenboli80@163.comBackground: Postoperative vitreous hemorrhage (POVH) after pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) is a common complication that delays visual recovery. While vitreous lavage (VL) mechanically clears hemorrhages, intravitreal ranibizumab (IVR) targets VEGF-mediated neovascularization. We compared the efficacy and safety of IVR and VL for the management of POVH.Objective: To compare the visual outcomes, hemorrhage clearance efficiency, and complications between IVR and VL over a 24-week follow-up period.Methods: In this prospective randomized controlled trial, 26 patients with POVH for PDR were allocated to the VL (n=12) or IVR (n=14) groups. Follow-up evaluations at 1 day, 1 week, 2 weeks, and monthly for up to 6 months included best-corrected visual acuity (BCVA) and complications. Novel metrics that included Visual Acuity Recovery Rate (VARR), Time to 1.0 logMAR-Equivalent Improvement (T1EI), and time to peak BCVA (Tpeak VA) quantified the recovery dynamics.Results: At 24 weeks, BCVA improvement was comparable between groups (VL: 0.30 LogMAR vs IVR: 0.22 LogMAR, p=0.47). VL achieved immediate BCVA gains in one day (1.99 vs 0.91 LogMAR, p< 0.01), whereas IVR demonstrated progressive improvement after 2 weeks. VARR was higher in VL at 1 day (0.76 vs 0.25, p< 0.001) and 2 weeks (0.84 vs 0.61, p=0.06) but converged by 24 weeks (p=0.86). The complication rates (recurrent hemorrhage and neovascular glaucoma) were similar (p> 0.05).Conclusion: VL and IVR were both associated with improved visual outcomes in patients with POVH throughout the 24-week follow-up period. The VL group achieved immediate BCVA improvement, and IVR showed a progressive improvement pattern. The VL group showed superior short-term efficiency. IVR showed a trend towards sustained recovery over the 24-week study period. In our study, IVR showed a trend of higher recovery efficiency within the follow-up timeframe. The advert treatment outcomes after the two treatments did not significantly differ. Thus, treatment selection should balance the urgency of visual rehabilitation and patient-specific factors.Keywords: postoperative vitreous hemorrhage, intravitreal ranibizumab, vitreous lavage