Early Vitrectomy for Spontaneous Fundus–Obscuring Vitreous Hemorrhages

Abstract

Abstract: : Purpose:Retinal tears are the most common cause of spontaneous, fundus–obscuring vitreous hemorrhage in non–diabetic eyes. Retinal detachment, frequently associated with proliferative vitreoretinopathy (PVR), and poor visual outcome, have recently been reported to occur in 39% to 79% of such eyes, if observation and delayed vitrectomy are utilized. The purpose of this study is to determine whether early vitrectomy in fundus–obscuring vitreous hemorrhage associated with spontaneous vitreous detachment would improve final anatomic and visual outcome. Methods:Chart review of eleven consecutive, non–diabetic patients with fundus–obscuring vitreous hemorrhage associated with posterior vitreous detachment, who underwent vitrectomy within two weeks of hemorrhage onset. Initial examination, ultrasound findings, surgical timing, operative findings, retinal treatment, and final anatomic and visual outcome was analyzed. Results:Retinal tear or tears were confirmed in 63% of eyes. Extra–macular rhegmatogenous retinal detachment were discovered in 45% of eyes. Cataract progression occurred in 27% of eyes with a mean follow up of 6 months. No additional retinal surgery was required in any eye, and no eyes developed proliferative vitreoretinopathy. All eyes (100%) achieved postoperative visual acuity of 20/30 or better. Conclusions:Eyes with fundus–obscuring vitreous hemorrhage and spontaneous posterior vitreous detachment should be considered for early vitrectomy to avoid an otherwise high rate of progression to rhegmatogenous retinal detachment and proliferative vitreoretinopathy with resultant poor visual outcome.

Keywords: vitreoretinal surgery • retinal detachment • retina