Early Vitrectomy for Spontaneous, Fundus-Obscuring Vitreous Hemorrhage.

Melamud A1, Pham H2, Stoumbos Z2.

Abstract

PURPOSE:

To examine the visual outcomes of early intervention in the setting of fundus-obscuring vitreous hemorrhage (VH) presumed to be due to posterior vitreous detachment.

DESIGN:

Retrospective comparative case series.

METHODS:

All eyes that presented with a fundus-obscuring VH defined as vision of 20/400 or worse, and requiring a B-scan at presentation from 2003 – 2013, were evaluated. Eyes with any history of retinopathy; macular degeneration; recent trauma; presentation greater than two weeks after onset of symptoms; or follow-up of less than two months were excluded. The main outcome measure studied was final best-correct visual acuity (BCVA) as dependent on the time to surgery.

RESULTS:

92 eyes met inclusion criteria with a mean follow-up of 490 days. Initial BCVA was logMAR 2.218 (Snellen equivalent 20/3000-20/4000 range 20/400- light perception); final BCVA was 0.318 (Snellen equivalent of 20/40-20/50 range 20/20 – light perception, p < 0.001). 56 patients (60.8%) had either a retinal tear or a retinal detachment. Patients who underwent surgery within 1 week had no significant improvement over all others, however a significant improvement was found when comparing early versus delayed surgery groups (p<0.05). There was a significantly increased risk of developing a macula-off retinal detachment in patients who did not undergo surgery within one week of presentation.

CONCLUSIONS:

Early surgical intervention results in similar visual outcomes compared to a conservative approach. However, early intervention significantly reduces the incidence of severe vision loss related to macula involving retinal detachment. This study highlights the importance of close follow-up given the high risk of retinal detachment in fundus-obscuring vitreous hemorrhage.
Am J Ophthalmol. 2015 Jul 21. pii: S0002-9394(15)00449-3. doi: 10.1016/j.ajo.2015.07.025. [Epub ahead of print]