Early vitrectomy in eyes with non-diabetic vitreous hemorrhage

Abstract

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.

Nontraumatic bilateral inferior ectopia lentis

“…Pars plana vitrectomy is an established treatment for eyes with rhegmatogenous retinal detachment (including challenging cases complicated by proliferative vitreoretinopathy) and with vitreoretinal interface syndrome and with aqueous misdirection. [ 3 4 5 6 ] but less so for different conditions. [ 7 8 9 10 ] Anterior iris–claw or retropupillary iris–claw IOL implant after vitreolensectomy has been suggested in EL eyes without capsular support;[ 11 12 ] decrease in the average endothelial cells density and cystoid macular edema are the main long-term complications described.…”

Re: Iwahashi et al.: Efficacy of inner wall retinectomy for bullous schisis cavity hanging over or threatening the macula in patients with congenital X-linked retinoschisis. Retina. 2023 Jan 1;43(1):64-71. doi: 10.1097/IAE.0000000000003633. Epub 2022 Aug 26.

“…Internal limiting membrane (ILM) peeling was performed as additional surgical step during a second PPV in one eye of this series, which had developed macular pucker and glaucoma postoperatively; therefore, it would be interesting to know whether its foveoschisis and macular appearance had changed compared with preoperatively. PPV (with or without ILM peeling) is an established treatment for eyes with vitreoretinal interface syndrome, with nondiabetic vitreous hemorrhage and with aqueous misdirection, [3][4][5][6][7][8] but less so for different conditions. 9,10 I commend the author's frank acknowledgement in the discussion of the limitations of this study but seek clarification of the raised points.…”

Early versus Late Pars Plana Vitrectomy in Vitreous Hemorrhage: A Systematic Review

“…Foo et al [27], in 2022, presented a retrospective study with 96 eyes comparing observation versus early PPV versus late PPV for non-diabetic VH. In the early group, vitrectomy was performed within a mean of 19.81 days, while in the late group it was performed within a mean of 126 days.…”