The Diabetic Retinopathy Vitrectomy Study (DRVS), a multicenter clinical trial program sponsored by the National Eye Institute, consisted of two randomized trials involving patients aged 18 to 70 years who had either type 1 (insulin-dependent) or type 2 (non-insulin-dependent) diabetes. In the first trial, the 616 patients had severe visual loss from recent severe vitreous hemorrhage in at least one eye. Eligible eyes were randomly assigned either to early vitrectomy or to conventional management. In the conventional management group, vitrectomy was carried out one year later if hemorrhage persisted; vitrectomy was carried out sooner if retinal detachment involving the center of the macula occurred
In the second trial, 381 patients were recruited, all of whom had severe fibrovascular proliferations and useful vision in at least one eye. Eligible eyes were assigned either to early vitrectomy or to conventional management. Conventional management included photocoagulation when indicated, with vitrectomy performed if a severe vitreous hemorrhage occurred and failed to clear spontaneously during a six-month waiting period or if retinal detachment involving the center of the macula occurred.
In the severe vitreous hemorrhage trial, two-year results showed that recovery of good vision (10/20 or better) was more frequent in the early vitrectomy group (25% vs. 15% in the conventional treatment group). However, there was also a trend toward more frequent loss of light perception in the early group (25% vs. 19%). In the patients with type 1 diabetes, who were younger and had more severe fibrovascular proliferations, the advantage of early vitrectomy was greater (36% with visual acuity of 10/20 or better in the early vitrectomy group, vs. 12% with conventional management) and the proportion losing light perception in the two groups was about equal (28% and 26%, respectively).
After four years of follow-up, investigators concluded that for eyes with recent severe vitreous hemorrhage, early vitrectomy provided a greater chance for prompt recovery of visual acuity. For patients with insulin-dependent diabetes, particularly for those in whom severe vitreous hemorrhage occurred after a shorter duration of diabetes, early vitrectomy provided a greater chance of recovering good visual acuity. This benefit remained at least as great after four years of follow-up as it was at two years.
The DRVS findings support early vitrectomy in eyes known or suspected to have very severe proliferative diabetic retinopathy (PDR) as a means of increasing the chance of restoring or maintaining good vision.
Selected Publications
The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy: Four-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study Report Number 5. Arch Ophthalmol 1990;108:958-964.
The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision: Clinical application of results of a randomized trial. Diabetic Retinopathy Vitrectomy Study Report Number 4. Ophthalmology 1988;95:1321-1334.
The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision: Results of a randomized trial. Diabetic Retinopathy Vitrectomy Study Report Number 3. Ophthalmology 1988;95:1307-1320.
The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy: Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study Report Number 2. Arch Ophthalmol 1985;103:1644-1652.
The Diabetic Retinopathy Vitrectomy Study Research Group. Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study Report Number 1. Ophthalmology 1985;92:492-502.
ETDRS Research Group, Kupfer C. The Diabetic Retinopathy Vitrectomy Study (editorial). Am J Ophthalmol 1976;81:687-690.
Click on the highlighted citations for summaries of studies
The Wisconsin Epidemiologic Study
Diabetes Control and Complications Trial Research Group
Early Treatment Diabetic Retinopathy Study Research Group
The Diabetic Retinopathy Study Research Group
UK Prospective Diabetes Study
This web resource is made possible through an unrestricted educational grant from Eli Lilly and Company.
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