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Neha P. Serrano, Alexander Melamud, Amy Nicholas-Hwang; Differences in Follow-Up Intervals in Patients Undergoing Pars Plana Vitrectomy for Fundus-Obscuring Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2011;52(14):538.
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To determine whether patients presenting with dense fundus-obscuring vitreous hemorrhage have a better visual outcome when monitored more frequently in clinic prior to vitrectomy surgery (PPV).
Records of 28 eyes of 28 patients (15 male and 13 female) who presented with fundus-obscuring vitreous hemorrhage (VH) from a posterior vitreous detachment (PVD) ranging in age from 41 to 93 years (mean 62.6 years) were retrospectively reviewed. Mean follow-up was 369 days (range from 60 days to 3.9 years). Data were collected regarding the follow-up intervals between clinic visits in the 11 patients who underwent PPV. The logarithm of the minimum angle of resolution-converted visual acuities was used for comparison. Initial and final best-corrected visual acuities (BCVA) were compared before and after surgical intervention. The number of eyes that developed either a retinal tear or detachment was recorded. Categorical data were analyzed using Fisher’s exact test, and population means were compared by Student’s t test.
Eleven of 28 eyes (39.29%) underwent PPV for either non-clearing VH or for a retinal detachment (RD) that was noted during the follow-up period. Six of 11 eyes (54.55%) developed a RD that was repaired with PPV with either gas and/or scleral buckling. An additional 5/11 eyes (45.45%) underwent PPV for non-clearing VH. For all 11 eyes, the mean initial BCVA was 20/3245, and the mean final BCVA was 20/67 (P=<0.0001). Mean time to PPV in the 11 patients was 21.36 days. The mean follow-up interval was 9.84 days for eyes undergoing PPV. In patients whose mean follow-up interval averaged less than 10 days between clinic visits (mean of 3.66 days), the mean final BCVA was 20/50 (N=7). Patients whose mean follow-up interval averaged greater than 10 days (mean 20.65 days) had a mean final BCVA of 20/122 (N=4). This difference was not statistically significant (P=0.3040). The mean follow-up interval was 12.68 days and 6.56 days for eyes undergoing PPV for RD and non-clearing VH respectively. This difference was not statistically significant (P=0.2891). There was a difference between the mean final BCVA in patients who underwent PPV for RD versus for non-clearing VH (20/136 versus 20/29 respectively, P=0.0217).
Eyes presenting with acute, fundus-obscuring vitreous hemorrhage due to PVD have a high incidence of retinal tears and detachment. Although statistical significance was not demonstrated, there is a trend towards better visual outcomes in patients who are followed in the clinic more frequently prior to vitrectomy surgery.
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