Vitreous hemorrhage

Abstract

The incidence of spontaneous vitreous hemorrhage is approximately 7 cases per 100,000 population. Proliferative diabetic retinopathy (32%), retinal tear (30%), proliferative retinopathy after retinal vein occlusion (11%) and posterior vitreous detachment without retinal tear (8%) are the most common causes of spontaneous vitreous hemorrhage. Vitreous hemorrhage can be caused by the pathologic mechanisms of disruption of normal retinal vessels, bleeding from diseased retinal vessels or abnormal new vessels, and extension of hemorrhage through the retina from other sources. Hemorrhage into the vitreous gel results in rapid clot formation and is followed by slow clearance of approximately 1% per day. The cellular response to vitreous hemorrhage is unusual with regard to hemorrhage in any tissue outside the vitreous cavity and has been compared to a "low-turnover" granuloma. Unique clinicopathologic features of long-standing vitreous hemorrhage include cholesterolosis bulbi (synchysis scintillans), hemoglobin spherulosis, and vitreous cylinders. Complications of nonclearing vitreous hemorrhage are hemosiderosis bulbi and glaucoma. Ghost cell glaucoma, hemolytic glaucoma, and hemosiderotic glaucoma may result from vitreous hemorrhage. The established treatment option for nonclearing vitreous hemorrhage is pars plana vitrectomy. Experimental nonsurgical treatment options involve improvement of physiologic clearance mechanisms in order to accelerate fibrinolysis, liquefaction, hemolysis and phagocytosis.

Comparison between clinical and ultrasound findings in patients with vitreous hemorrhage

“…The relative prevalence of these and other underlying conditions has varied in previous reports. [1][2][3][4][5] Despite recent improvements in ophthalmologic examination techniques, evaluation of vitreoretinal diseases with V-HEMO often presents a diagnostic challenge even when using the standard methods of A-and B-scan ultrasound (U/S). We conducted a retrospective study of the underlying causes of dense V-HEMO.…”

Vitreous haemorrhage without obvious cause: national survey of management practices

“…2 However, historically the management recommendation for vitreous haemorrhage of unknown cause has been conservative. 2 At presentation, strict rest with head upright in the first few days may allow sufficient settling of blood and view of superior retina where pathology will most likely exist. 9 As spontaneous clearing of the vitreous may occur, it can sometimes be reasonable to monitor patients closely.…”

“…1,2 Dynamic vitreoretinal traction is the most common cause and includes posterior vitreous detachment (PVD) with retinal tear (B30-40%) or detachment (B5%), or PVD without retinal tear (B3-8%). [1][2][3] If all presenting haemorrhages are considered, the diagnosis can be made at presentation in about 80% of cases, 3 as there is adequate fundus view. Medical history assists diagnosis, with diabetes and other vascular diseases (eg hypertension, branch retinal vein occlusion, retinal macroaneursym, ARMD) also significant causes of spontaneous vitreous haemorrhage.…”

“…Medical history assists diagnosis, with diabetes and other vascular diseases (eg hypertension, branch retinal vein occlusion, retinal macroaneursym, ARMD) also significant causes of spontaneous vitreous haemorrhage. 2 The fellow eye examination and past ocular history likewise provide helpful clues to underlying aetiology of the haemorrhage. 1,3 Diagnosis at presentation is easier when the haemorrhage is minor and an adequate view of the retina is obtained.…”

Spontane Makulablutung

“…Somit sind heute die gefürchte-ten Komplikationen einer persistierenden Netzhaut-Glaskörper-Blutung wie u. a. Schäden der Retina durch Blut und Blutabbauprodukte, epiretinale Membranen, proliferative Vitreoretinopathie und unterschiedliche Makulopathien vermeidbar [26]. Bei umschriebenen und weniger stark ausgeprägten präretinalen Blutungen speziell auch bei jüngeren Patienten wie in unserem ersten Fall sind allein regelmäßige Kontrollen in Hinblick auf eine mögliche Spontanresorption mit guten funktionellen Ergebnissen gerechtfertigt [14,27].…”