Acute, Spontaneous Posterior Vitreous Detachment (PVD) has been associated with a reported 10%–15% incidence of retinal tears.1 However, when acute PVD is associated with vitreous hemorrhage, the incidence of retinal tears rises to reported rates of 54%–91%.2–8
In the setting of a dense fundus-obscuring vitreous hemorrhage, the clinical examination is made more difficult by an inability to visualize the fundus. In these cases, B-scan ophthalmic ultrasonography is used to rule out an underlying retinal tear or detachment. Studies looking at the accuracy of ultrasonography in determining the presence of retinal tears have demonstrated variable results.9,10
Given the high risk of underlying retinal pathology, an important consideration becomes whether early surgical intervention with pars plana vitrectomy (PPV) results in improved visual and anatomic outcomes as compared to careful monitoring. The decision to intervene must balance the risks of vitrectomy vs the risk of missing an underlying tear and not responding in a timely fashion.11–13
Several noncomparative studies have looked at the question of appropriate patient management in patients with an acute dense vitreous hemorrhage in the setting of PVD. One retrospective observational case series concluded that the incidence of underlying pathology is high but close observation is appropriate in many cases, except in those individuals who have a history of retinal detachment in the contralateral eye.14 Two studies analyzed patients treated with early vitrectomy and concluded that surgical management is both safe and effective.15,16 A gap in the literature has been a study comparing 2 management approaches in a similar setting. We set out to design a comparative analysis to determine whether, in patients presenting with a dense, fundus-obscuring vitreous hemorrhage from presumed PVD, early surgical intervention results in improved patient outcomes.
Full Paper: Early Vitrectomy for Spontaneous Fundus-Obscuring Vitreous Hemorrhage