Early vitrectomy for dense vitreous hemorrhage in adults with non-traumatic and non-diabetic retinopathy

Abstract

ObjectiveTo evaluate the etiologies for dense vitreous hemorrhage in adults with non-traumatic and reveal management of early vitrectomy for the disease.MethodsStudy included 105 eyes from 105 patients. Outcome measures were etiologies of vitreous hemorrhage, formation of retinal and/or disk neovascular membrane (NVM), incidence of retinal tear and detachment, visual acuity (VA) and postoperative complications.ResultsMean time between presentation and surgery was 7.1 days. The most common etiologies were retinal vein occlusion (RVO) (58.1%), retinal tear (22.9%) and retinal vasculitis (10.4%). Most RVO (77.0%) and retinal vasculitis (72.7%) eyes were associated with retinal and/or disk NVM. Retinal tear and retinal detachment was found in 24 and 48 eyes, respectively. VA improved significantly from 1/70 to 0.6 following vitrectomy. The most common postoperative complication was cataract (28.6%).ConclusionRVO, retinal tear and retinal vasculitis were the most common causes of dense vitreous hemorrhage. Early vitrectomy has a good outcome with acceptable complication rates in this setting.

Pars Plana Vitrectomy for Vitreous Hemorrhage in Ciptomangunkusumo Hospital

“…3,5,8 In this study, PDR was the most common cause of vitreous hemorrhage (49.4%). This finding differs with Zhang et al 9 that reported age macular degeneration (AMD) was the most common cause.…”

Clinical profile and surgical outcome of pars plana vitrectomy in non-diabetic vitreous hemorrhage

“…Vitrectomy combined with laser photocoagulation and with or without tamponade agents according to the etiology is the recommended treatment for vitreous hemorrhage. 6 The causes of poor visual outcome less than 6/60 were chorioretinal scar in four eyes, optic atrophy in one eye and epiretinal membrane formation in one eye. The complications of vitrectomy were seen in 8 (17.4%) eyes.…”

“…The severity of vitreous hemorrhage was graded on a 5-point scale from a previous study: Grade 0 (no vitreous hemorrhage); Grade 1 (minimal vitreous hemorrhage, optic disk, and retinal vessels were clearly visible); Grade 2 (mild vitreous hemorrhage, most of the optic disk, and retinal vessels were visible); Grade 3 (moderate vitreous hemorrhage, optic disk, or retinal vessels were barely visible); and Grade 4 (severe vitreous hemorrhage was too dense to allow visualization of the optic disk). 6 Early vitrectomy was defined as the time between decision for surgery and actual surgery if done within 7 days. We included cases with early vitrectomy for vitreous hemorrhage of Grade 3 or 4 that had a follow-up of at least 3 months.…”

Diabetic eye disease: A review of screening and management recommendations

“…In cases of VH in the setting of PDR, the haemorrhage may clear over time with conservative measures, and prognosis is generally good for regaining baseline VA. However, vitrectomy is recommended for patients who have VH refractory to conservative therapy, significant haemorrhage, or co‐morbidities like retinal tears or significant tractional membranes 92 . Furthermore, the Diabetic Retinopathy Vitrectomy Study demonstrated that type 1 diabetics with poor VA due to a non‐clearing VH should undergo early vitrectomy (ie, within 6 months) 93 .…”

“…However, vitrectomy is recommended for patients who have VH refractory to conservative therapy, significant haemorrhage, or co-morbidities like retinal tears or significant tractional membranes. 92 Furthermore, the Diabetic Retinopathy Vitrectomy Study demonstrated that type 1 diabetics with poor VA due to a non-clearing VH should undergo early vitrectomy (ie, within 6 months). 93 Early vitrectomy should also be considered in any diabetic patient with anterior hyaloidal fibrovascular proliferation, refractory macular oedema, progressive proliferative retinopathy despite PRP, and/or ghost cell glaucoma from long-standing VH.…”