NOV 15, 2010
Investigators reviewed the medical records of 39 consecutive patients (40 eyes) who underwent early vitrectomy for vitreous hemorrhage between 2007 and 2009 and were followed up for at least three months. All cases had presence or suspicion of retinal tears.
Of a total of 69 tears found, a high number of new tears (46.4 percent) were identified only during vitrectomy as they were missed by preop funduscopy and ultrasound. The rest were identified preoperatively by fundoscopy or ultrasound. After a mean follow-up of more than 19 months, mean visual acuity improved from 1/60 to 0.8 (P < 0.001). Postoperative complications were cataract (30 percent), macular pucker (2.5 percent), and retinal detachment (5 percent).
A history of predisposing factors was unrelated to the risk of unsupported tears during vitrectomy. In two cases, a retinal detachment developed between the ultrasound evaluation and vitrectomy. In as much as 40 percent of the cases the tears were found in lower quadrants, which calls into question the presumption that it suffices to evaluate only the upper quadrants for presence of tears.
The authors conclude that this study illustrates the inherent risk of the typical, conservative approach to managing a vitreous hemorrhage of unknown cause - upright positioning combined with immobilization and bilateral patching - since the presence of an unsupported or untreated retinal tear carries an unacceptable risk of progression to retinal detachment with increased risk of proliferative vitreoretinopathy. Since vitrectomy also has its own well-documented risks, the authors recommend a controlled, prospective study on this issue.