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R.M. Lieberman, C. Zatezalo; Use of Vitrase® for Vitreous Hemorrhage in Non–Surgical Candidates . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1446.
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Many patients with vitreous hemorrhage (VH) would benefit from surgical intervention (PPV), but for various reasons, are not surgical candidates. We assessed the efficacy of Vitrase® (highly purified ovine hyaluronidase) for clearing vitreous hemorrhage in these patients.
10 patients (10 eyes) with VH, who were non candidates for surgical intervention were treated with a single intravitreal injection of Vitrase®. The following parameters were evaluated: visual acuity (at multiple time points), ability of examiner to evaluate the retina and place appropriate therapy, complications, and patient satisfaction.
Eight (8) eyes received treatment with intravitreal Vitrase®. The ages ranged from 31–79 yr, with a 5:3 male–female ratio. Etiology for VH included diabetic retinopathy (6), venous occlusive disease (1) and sickle cell retinopathy (1). Etiologies for inclusion (definition: non–surgical candidate) were poor health, psychiatric illness, and patient unwillingness to have surgery. Follow up ranged from 3–6 months. All VH had been present at least 1 month (range 1 month to >6 months). At presentation, all visual acuities were off the chart [count fingers(CF) or worse]. At 2 weeks, 2 patients had achieved 20/50 or better, and another 2 were ≥ 20/200. At one month, 5 were ≥ 20/100. Six patients achieved ≥ 20/400 at 3 months, with three ≥20/50, and two ≥ 20/200. Two patients remained CF or HM for the duration of their follow up.
Interestingly, of the 3 patients who quickly achieved 20/50 or better (within 2–4 weeks), all had a vitreous hemorrhage duration of less than 6 weeks. Of the 3 patients having VH duration ≥3 months, only 1 achieved any increase in VA. Improvement in VA correlated with ability to evaluate retina and place appropriate therapy. There were no visually significant complications. In addition,100% of patients stated they would repeat the procedure, if necessary.
Vitrase® can be successfully used as an alternative to pars plana vitrectomy in patients with vitreous hemorrhage who are not surgical candidates. Patients with vitreous hemorrhage duration of less than 6 weeks had a more rapid and significant improvement of VA, in addition to the ability treat the underlying etiology of the VH. A majority of patients expressed satisfaction with the procedure.
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