Impact of Early Vitrectomy for Dense Vitreous Hemorrhage of Unknown Etiology

Abstract

Background: Surgical intervention for dense vitreous hemorrhage (DVH) with unclear etiology is often delayed in favor of conservative follow-up despite possible disease progression and the availability of safe minimally invasive vitrectomy.

Objectives: The aim of this study is to investigate the efficacy of early surgical intervention for DVH with unknown etiology.

Methods: Eighty-eight cases (88 eyes) of DVH with unknown origin were retrospectively reviewed. Inclusion criteria were as follows: (1) measured visual acuity (VA) of 20/200 or worse and (2) fundus invisibility requiring B-scan ultrasonography. Eyes with a history of diabetic retinopathy, recent trauma, or likely retinal detachment (RD) as revealed by B-scan ultrasonography were excluded. Outcome measures were a cause of vitreous hemorrhage and final VA following early (≤2 weeks after symptom onset) or delayed vitrectomy.

Results: The most frequently occurring causes of DVH were central or branch retinal vein occlusion (30 eyes, 34%) and retinal tear or RD (29 eyes, 33%). logMAR VA significantly improved after treatment (p < 0.001). Final VA was significantly higher for eyes treated within 2 weeks compared with eyes treated later than 2 weeks after symptom onset (p = 0.020).

Conclusions: Surgical intervention within 2 weeks after symptom onset may prevent a lower visual outcome.

Keywords: Retinal detachment; Retinal vein occlusion; Vitrectomy; Vitreous hemorrhage.