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N. P. Serrano, A. L. Nicholas, A. Melamud; Conservative Management versus Early Vitrectomy in Patients Presenting With Fundus-Obscuring Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1752.
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To determine final visual outcomes and the incidence of retinal detachment in eyes presenting with acute, spontaneous, dense, fundus-obscuring vitreous hemorrhage likely resulting from posterior vitreous detachment when managed conservatively versus with early vitrectomy.
Records of 35 eyes (17 right and 18 left) of 35 patients (19 male and 16 female) ranging in age from 41 to 93 years (mean 63.8 years) were retrospectively reviewed. Mean follow-up was 11.33 months (range from 2 to 47 months). The logarithm of the minimum angle of resolution-converted visual acuities (LogMAR) was used for comparison. Initial and final best-corrected visual acuities were compared before and after either spontaneous clearing of the vitreous hemorrhage or surgical intervention. The number of eyes that developed a retinal tear or retinal detachment was recorded. Categorical data were analyzed using Fisher’s exact test, and population means were compared by Student’s t test.
Eleven of 35 eyes (31.42%) were found to have at least one retinal tear. Six of 35 eyes (17.14%) developed a retinal detachment that was repaired with pars plana vitrectomy with either gas and/or scleral buckling. An additional 9/35 eyes (25.71%) underwent vitrectomy for non-clearing vitreous hemorrhage. For all 35 eyes, the mean initial best-corrected visual acuity was 20/3312, and the mean final best-corrected visual acuity was 20/37 (P=<0.0001). There was a difference in the final visual results between eyes that underwent pars plana vitrectomy (20/61) versus eyes that did not (20/25, P=0.0022). A difference was also noted between the final visual outcome in eyes that underwent early vitrectomy (20/24, defined as vitrectomy performed within one week of presentation) and eyes that did not (20/97, P=0.0145).
Eyes presenting with acute, fundus-obscuring vitreous hemorrhage due to posterior vitreous detachment have a high incidence of retinal tears and detachment. There may be a benefit from early surgical intervention in these patients.
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