The Use of Ovine Hyaluronidase (Vitrase®) in Non-Clearing Vitreous Hemorrhage of Varying Durations

Abstract

Purpose:: To ascertain the efficacy of an intravitreal injection of ovine hyaluronidase (Vitrase®) in patients with non-clearing vitreous hemorrhage (VH) of varying durations, and to determine any influence of systemic anti-coagulation therapy.

Methods:: Retrospective chart review was performed on 19 consecutive patients (20 eyes) who received a single intravitreal injection of Vitrase® (55IU/0.05ml) for non-clearing VH to include the following : patient demographics, best corrected visual acuity (BCVA), use of systemic anti-coagulation therapy (either aspirin, Plavix®, or Coumadin®), re-bleeding events, ability to perform definitive laser treatment secondary to clearance of VH, complications.

Results:: Nineteen (19) patients (20 eyes) were included. Mean age was 56 yrs. (range 37-72), with initial BCVA ranging from 20/70 to LP. Follow-up ranged from 1 to 10 months, with a mean of 4 months. Etiologies of VH included proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Six (6) eyes were found to have an improvement of 3 or more lines in BCVA, regardless of duration of VH. Three (3) eyes were found to have a 1 or 2 line improvement. Three (3) eyes were lost to follow-up. BCVA improved 3 or more lines in 40% of eyes with non-clearing VH of up to two months of duration (5 eyes). Pan retinal photocoagulation (PRP) was placed in 100% of these eyes, with none of this subset experiencing a re-bleed. In the second group of eyes with non-clearing VH (3 or more months’ duration [12 eyes]), 33% demonstrated a 3 or more line improvement in BCVA and 25% demonstrated a 1 or 2 line improvement. Re-bleeding occurred in 16.7% of eyes in this group, with 50% able to have PRP placed. Furthermore, 50% of all eyes that improved 3 or more lines used systemic anti-coagulation therapy, as compared to 66% of eyes that demonstrated a 1 to 2 line improvement, and 33% with no improvement in BCVA. None of the patients who re-bled were on systemic anti-coagulation therapy. No significant complications were noted.

Conclusions:: In this series, the use of Vitrase® in the treatment of non-clearing VH appears to be safe and efficacious. Although only one third of the eyes demonstrated an improvement of 3 lines or better in BCVA, the majority of these eyes were able to have definitive PRP placed. There appeared to be no correlation between the use of systemic anti-coagulation therapy and improvement in BCVA, or with re-bleeding incidents.

Keywords: diabetic retinopathy • vitreous • injection