Early Vitrectomy for Spontaneous, Fundus-Obscuring Vitreous Hemorrhage

Melamud, Alexander; Pham, Hubert; Stoumbos, Zoey

doi:10.1016/j.ajo.2015.07.025

Cited by 20 publications

(11 citation statements)

References 17 publications

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“…Melamud et al recently published a comprehensive description of the clinical care of 92 patients presenting with acute FOVH. 15 Thirteen eyes that underwent vitrectomy ultimately were found to have a diagnosis other than PVD as the cause of their FOVH. The rate of cataract formation after vitrectomy was high with 32 out of 49 phakic patients undergoing cataract surgery by the study end.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Sandinha¹,

Kotagiri²,

Owen³

et al. 2017

OPTH

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PurposeTo assess the accuracy of B-scan ultrasound (U/S) in diagnosing cases of acute fundus obscuring vitreous hemorrhage (FOVH) using a standardized scan protocol and dedicated ophthalmic ultrasonographer.MethodsConsecutive patients presenting with acute FOVH of unknown cause, between January 2013 and December 2014, were prospectively recruited. Patients underwent a scan performed by a dedicated ultrasonographer, utilizing a systematic scan sequence and using an ocular specific U/S device. The U/S findings were compared to the findings during vitrectomy or after spontaneous hemorrhage clearance.ResultsFifty-eight eyes (58 patients) were included. An underlying rhegmatogenous retinal detachment (RRD) and retinal tears without RRD were reported in nine and 14 patients, respectively. Nineteen of these patients underwent vitrectomy, and the other four underwent laser retinopexy or cryopexy alone. An additional six patients with suspected but uncertain retinal tears underwent vitrectomy, during which tears were confirmed in three, two had retinal vessel avulsions, and one had retinal new vessels. There was “complete” agreement between the B-scan findings and clinical findings in 78% of patients, “partial” agreement in 19%, and agreement was not tested in 3%. When the agreement was “partial”, the disagreements did not affect patient management. The sensitivity was 100% for the detection of RRD, and for the detection of new retinal tears in patients without retinal detachment.ConclusionB-scan U/S scan was highly sensitive in identifying the pathology in acute FOVH. Our results show an improvement from previously reported results, likely related to the standardized scan protocol and dedicated ophthalmic ultrasonographer.

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Section: Discussionmentioning

confidence: 99%

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Sandinha¹,

Kotagiri²,

Owen³

et al. 2017

OPTH

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“…However, previous literature suggested that early PPV will reduce the overall RRD rate in this group of patients. 9 In this series, the choice between surgical and non-surgical management depended on diagnosis and on the assessment of the vitreoretinal surgeons involved, and NDVH was caused by PVD in almost two-thirds of the patients (62.5%, n = 60). Surgical intervention was required in 75.7% (n = 28) of patients who had hPVD associated with RT.…”

Section: Discussionmentioning

confidence: 92%

“…However, previous literature suggested that early PPV will reduce the overall RRD rate in this group of patients. 9 …”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, these patients are observed in an outpatient setting with serial ultrasound scans. 9 Treatment is then undertaken once the view becomes clear enough to make a diagnosis (such as in the case of RVO or RT). PPV is an established treatment for eyes with RRD (including challenging cases complicated by PVR), with vitreoretinal interface syndrome and with aqueous misdirection, [10][11][12] but less so for NDVHs.…”

Section: Discussionmentioning

confidence: 99%

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Early vitrectomy in eyes with non-diabetic vitreous hemorrhage

2022

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Background: Optimal management of non-diabetic vitreous hemorrhage (NDVH) is controversial, and reliability of B-scan ultrasonography in detecting retinal tears (RTs) has been reported to be highly variable by previous literature. Objectives: To report outcomes of conservative versus surgical management of NDVH and reliability of B-scan ultrasonography in detecting RTs and rhegmatogenous retinal detachment (RRD). Design: Retrospective observational single-center cohort study. Methods: Ninety-six consecutive NDVH from 96 eyes (96 patients) with minimum follow-up duration of 12 months were included. Results: Seventy-two eyes (75%) underwent early pars plana vitrectomy (PPV), 19 (20%) were managed conservatively and 5 (5%) underwent late PPV. Initial mean best corrected visual acuities (BCVAs) were 1.95 ± 1.19, 1.19 ± 1.38, and 1.14 ± 1.04 logMAR respectively, the difference was statistically significant ( p = 0.039). Mean final BCVAs were 0.92 ± 1.19, 0.59 ± 0.87, and 1.25 ± 1.89 logMAR, respectively, the difference was not significant ( p = 0.447). When comparing initial and final BCVAs, the difference was significant only in the early PPV group ( p = 0.00001) and was not significant in the conservative group ( p = 0.066) and in the late PPV group ( p = 0.46). Complications included RRD ( n = 2) and re-bleed in vitrectomized cavity ( n = 1) in the early surgical group, need for additional laser or cryoretinopexy to RTs ( n = 2), retinal detachment ( n = 1), neovascular glaucoma ( n = 1), persistent vitreous hemorrhage ( n = 2) in the conservative group. B-scan ultrasound showed preoperative 11.53% sensitivity and a 60.0% positive predictive value for diagnosing retinal tears (RTs) in NDVH. Conclusion: The benefit of early PPV in NDVH seems to outweigh the risks of surgery, especially in the context of low sensitivity of B-scan in identifying RTs, and significant improvement in final BCVA following surgery may occur. NDVH should be promptly referred to vitreoretinal services, as surgery may be a safer and more advisable option.

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“…Longer waiting periods risk proliferative vitreoretinopathy, retinal detachment, and retinal scarring. 66 Alternative non-invasive approaches, such as primary scleral buckling can reduce the rate of subsequent retinal detachments. 67 Consider cultures and prophylactic intravitreal antibiotics in contaminated or delayed cases.…”

Section: Vitreoretinal Surgerymentioning

confidence: 99%

Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls

Zhou¹,

DiSclafani²,

Jeang³

et al. 2022

OPTH

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Ocular trauma may either be closed globe or open globe. Open globe injuries are full-thickness defects of the eyewall and are often differentiated by the mechanisms of injury from which they are caused: sharp or blunt trauma. They are ocular emergencies and can lead to substantial visual morbidity. Without timely intervention, damage is irreversible and leads to permanent vision loss. The goals of evaluation are to identify the mechanism of injury, characterize the extent of injury, and gather relevant history. If an open globe is suspected, ophthalmologic consultation should be requested. Once an open globe is diagnosed, preparations for surgery should be made immediately and steps should be taken to avoid further injury. Intraocular infection risk is relatively high, requiring immediate empiric systemic antibiotics. Emergent surgical exploration and primary closure is indicated whenever possible. After initial closure, secondary surgery and revision may be needed to improve vision outcomes, followed by extensive follow-up. In this review, best practices for evaluation and management are reviewed, with particular focus on the surgical approach and techniques.

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Early Vitrectomy for Spontaneous, Fundus-Obscuring Vitreous Hemorrhage

Cited by 20 publications

References 17 publications

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Early vitrectomy in eyes with non-diabetic vitreous hemorrhage

Open Globe Injuries: Review of Evaluation, Management, and Surgical Pearls

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