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Matthew A. Cunningham, Brian Chan Kai, Petros E. Carvounis; Visual and Anatomic Outcomes with Pars Plana Vitrectomy for Non-Clearing Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6121.
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Vitreous hemorrhage (VH) may fail to spontaneously resolve within 3 months and while present may result in severe visual impairment. Non-clearing vitreous hemorrhage (NCVH) is a common indication for a pars plana vitrectomy.The purpose of this study is to determine the outcomes of patients who underwent vitrectomy for NCVH over a 2 year period. Also, to evaluate surgical complications and recurrence rates of VH after surgical intervention, with various vitrectomy systems utilized.
Included were patients who underwent pars plana vitrectomy due to NCVH at a single institution from August 2007 to December 2009 by the vitreoretinal service. The primary outcome measure was the change in visual acuity (VA). Secondary outcome measures included the rate of VH recurrence, rate of surgical complications, and anatomic success. Exclusion criteria included follow-up less than 6 months.
Forty-seven patients (46 males, 1 female; mean age, 61.4 years [range 44-87]) met the inclusion criteria. Diagnoses included NCVH secondary to proliferative diabetic retinopathy (37 patients), retinal vascular occlusions (7), trauma (1), retinal tear (1), and macular degeneration (1). Mean post-operative follow-up of patients was 17 months (6-37 months). A 20-, 23-, and 25-gauge vitrectomy system was used in 11, 26, and 10 patients, respectively.Prior to vitrectomy, 6/47 patients had VA >/= 20/400 (mean logMAR of +0.98), while post-vitrectomy, 28/47 patients had VA >/= 20/400 (mean logMAR of +0.43). Snellen VA was improved in 35/47 patients, with 27 patients improving 2 lines or more. Recurrence of VH was seen in 5 patients (10.6%), 1 to 16 months after the vitrectomy (mean 7.8 months). Patients with recurrent VH demonstrated light perception to 2/200 VA at last examination. Surgical complications occurred in 2 patients (4.2%) - one patient had an iatrogenic retinal break while the other had a peripheral retinal tear leading to a rhegmatogenous retinal detachment. Thirty-three patients were pseudophakic, and 13 were phakic; one patient was aphakic. Five patients required additional vitreoretinal procedures to treat either tractional and/or rhegmatogenous retinal detachments or recurrent vitreous hemorrhage. At last follow-up examination, all patients except one displayed anatomical success.
The use of vitrectomy in patients with non-clearing vitreous hemorrhage was effective in improving the visual acuity of most patients in this series. Recurrence of vitreous hemorrhage may occur and can require additional vitreoretinal surgery.
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