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L. Yeung, N.–K. Wang, Y.–P. Chen, K.–J. Chen, W.–C. Wu, T.–L. Chen, C.–C. Lai; The Severity of Vitreous Hemorrhage Associated With Visual Recovery of Primary Rhegmatogenous Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5268.
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To elucidate the relationship between the severity of preoperative vitreous hemorrhage and visual outcome of primary rhegmatogenous retinal detachment without previous vitreoretinal surgery.
Retrospective chart review of patients presenting with rhegmatogenous retinal detachment and vitreous hemorrhage between January 1993 and December 2002. Patients with proliferative diabetic retinopathy, tractional retinal detachment and open–globe injury were excluded. Vitreous hemorrhage was classified into three grades: (1) mild (not preventing detailed fundus examination), (2) moderate (obscuring at least one or two quadrants of retinal detail, but still allowing identification of retinal tears), (3) severe (too dense for visualization of the optic disc and identification of the retinal tears).
This study included 71 eyes from 71 patients with a mean age of 48.0 years (range, 7–78 ) and a median follow–up period of 19 months (range, 12–140 months). Twenty–one eyes were found to have mild vitreous hemorrhage, 17 eyes had moderate, and 33 eyes had severe vitreous hemorrhage. Eyes with severe vitreous hemorrhage had significant older age (p=0.002), longer duration of hemorrhage (p=0.004), worse presenting visual acuity (p<0.001), worse final visual acuity (p<0.001), and a higher incidence of severe (Grade C) proliferative vitreoretinopathy (p=0.002) when compared with mild to moderate vitreous hemorrhage group. The recurrent rate of retinal detachment after first operation was around 21% in both severe vitreous hemorrhage group and mild to moderate group (p=0.987). Addition of encircling scleral buckle during vitrectomy did not increase the anatomic success rate after first operation in severe vitreous hemorrhage group. By multivariable analysis, the severity of vitreous hemorrhage (p<0.001), recent (within 3 months) cataract surgery (p=0.012), macular status (p=0.001), development of severe proliferative vitreoretinopathy (p=0.003), and total number of vitreoretinal surgery (p=0.001) were independent factors associated with final visual outcome.
The severity of vitreous hemorrhage is an independent prognostic factor in the visual outcome of primary rhegmatogenous retinal detachment. Severe vitreous hemorrhage is associated with higher incidence of severe proliferative vitreoretinopathy and worse visual outcome.
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