ArticleClinical ophthalmology (Auckland, N.Z.)2026
Posterior Vitreous Detachment Determines the Clinical Impact of Fibrovascular Membrane Fibrosis After Anti-VEGF Treatment in Proliferative Diabetic Retinopathy: A Real-World Study.
Article in Clinical ophthalmology (Auckland, N.Z.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To investigate the relationship between posterior vitreous detachment (PVD) status and fibrovascular membrane (FVM) angio-fibrotic transformation following anti-VEGF therapy in advanced proliferative diabetic retinopathy (PDR), and their combined impact on disease progression and visual outcomes. Methods: This prospective real-world study enrolled 165 treatment-naïve PDR patients with vitreous hemorrhage (VH) and FVM who received intravitreal anti-VEGF injection followed by panretinal photocoagulation(PRP) when possible. PVD status and FVM characteristics were monitored during a median follow-up of 13.0 months. Cox proportional hazards and Kaplan-Meier analyses evaluated factors influencing visual prognosis and timing of surgical intervention. Results: FVM fibrosis occurred in 43% of patients, with distinct PVD-dependent patterns: predominantly in complete PVD cases, moderately in partial PVD, and rarely without PVD. Multivariate analysis identified macular involvement as the strongest risk factor for poor visual outcomes (HR=3.65), while PVD (HR=0.37) and FVM fibrosis (HR=0.023) were strongly protective. Patients with both PVD and FVM fibrosis maintained stable vision longest (median 28.5 months) and demonstrated significantly longer surgery-free survival (28.3 months) compared to those without either condition (3.2 months, p<0.0001), who frequently presented with vitreoschisis and recurrent VH disproportionate to visible FVM grade. Conclusion: PVD status critically determines the clinical manifestation and prognosis of post-anti-VEGF FVM fibrosis in PDR. This PVD-dependent pattern challenges the conventional view that FVM fibrosis inevitably leads to "Crunch syndrome" and creates a risk stratification framework that can guide individualized surgical timing decisions, potentially improving functional outcomes in advanced PDR.
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