Vitrectomy for the Management of Vitreous Hemorrhage : Clinical Characteristics and Surgical Outcomes

Astriviani Switania (1) , Elvioza (2) , Waldensius Girsang (3) , Soefiandi Soedarman (4) , Referano Agustiawan (5)
(1) , Indonesia
(2) , Indonesia
(3) , Indonesia
(4) , Indonesia
(5) , Indonesia

Abstract

Purpose: Vitreous hemorrhage (VH) can cause sudden loss of vision. Conservative management is sometimes employed, yet potential risk due to delayed diagnosis and definitive treatment is concerning. Vitrectomy for VH can reduce such risk by confirming the etiology and providing surgical treatment. This study was conducted to evaluate the clinical characteristics and surgical outcomes of vitrectomy for VH in our center.


Methods: A descriptive study was conducted. Data were collected retrospectively from patient’s medical records who underwent vitrectomy for VH from January to December 2020, including pre-operative clinical characteristics, surgical and adjunctive intervention, and postoperative findings. Statistical analysis was conducted. Comparison of final visual acuity to baseline visual acuity was analyzed.


Results: There were 164 eyes from 164 subjects who underwent vitrectomy due to VH included in this study. The mean age of the subjects was 55,2 ± 9,8 years. Most of the subjects had severe VH pre-operatively (84,7%). Diabetic retinopathy was the most common etiology (45,1%), followed by breakthrough from submacular hemorrhage (29,9%) and retinal vein occlusion (10,3%). Most of the subjects (87,2%) underwent early vitrectomy. Final visual acuity in all subject groups improved significantly compared to baseline visual acuity (p = 0,00; p < 0,05). Final visual acuity in subjects with breakthrough from submacular hemorrhage was lower compared to other etiology. Complications after vitrectomy were recurrent VH (10,3%) and increased intraocular pressure associated with silicone oil (1,82%).


Conclusion: Early vitrectomy appears to be beneficial for VH. Visual acuity varies regarding the etiology, nevertheless, was maintained or improved in most subjects.

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References

Spraul CW, Grossniklaus HE. Vitreous hemorrhage. Surv Ophthalmol. 1997;42(1):3–39.

lindgren G and Lindblom B. Causes of vitreous hemorrhage. Current opinion in ophthalmology. 1996;3:13-19.

Lindgren G, Sjodell L, Lindblom B. A prospective study of dense spontaneous vitreous hemorrhage. Am J Ophthalmol. 1995;119(4):458–65.

Melamud A, Pham H, Stoumbos Z. Early vitrectomy for spontaneous, fundus-obscuring vitreous hemorrhage. Am J Ophthalmol. 2015;160(5):10731077.

Pighin MS, Berrozpe C, Jurgens I. Outcome of acute nontraumatic vitreous hemorrhage in healthy patients. Retina. 2020;40(1):87–91. 6. Zhang T, Zhang J, Sun X, Tian J, Shi W, Yuan G. Early vitrectomy for dense vitreous hemorrhage in adults with non-traumatic and non-diabetic retinopathy. J Int Med Res. 2017;45(6):2065–71.

Kim DY, Joe SG, Baek S, Kim JG, Yoon YH, Lee JY. Acute-Onset Vitreous Hemorrhage of Unknown Origin before Vitrectomy: Causes and Prognosis. J Ophthalmol. 2015;2015.

Yeung L, Liu L, Wu WC, Kuo YH, Chao AN, Chen KJ, et al. Reducing the incidence of early postoperative vitreous haemorrhage by preoperative intravitreal bevacizumab in vitrectomy for diabetic tractional retinal detachment. Acta Ophthalmol. 2010;88(6):635–40.

Manandhar LD, Thapa R, Poudyal G. Clinical profile and management of vitreous hemorrhage in tertiary eye care centre in Nepal. Nepal J Ophthalmol. 2020;12(1):99–105.

Sharma R, Joshi SN, Shrestha JK. Etiology of vitreous hemorrhage in a tertiary eye care center in Nepal. Nepal J Ophthalmol. 2010;2(2):121–6.

Connors D, Shah G, Blinder K, Dang S. Early Versus Delayed Vitrectomy for Nondiabetic Vitreous Hemorrhage. J Vitreoretin Dis. 2018;2(2):87–90.

Hayashida M, Miki A, Imai H, Otsuka K, Azumi A, Nakamura M. Impact of Early Vitrectomy for Dense Vitreous Hemorrhage of Unknown Etiology. Ophthalmologica. 2019;242(4):234–8.

Fassbender JM, Ozkok A, Canter H, Schaal S. A comparison of immediate and delayed vitrectomy for the management of vitreous hemorrhage due to proliferative diabetic retinopathy. Ophthalmic Surg Lasers Imaging Retin. 2016;47(1):35–41.

Nagpal M, Mehrotra N, Vishnoi A. The Role of Perioperative Anti-VEGF During Vitrectomy for Vitreous Hemorrhage in Relation to Postoperative Nonclearing Vitreous Hemorrhage and Cystoid Macular Edema. J Vitreoretin Dis. 2017;1(6):379–84.

Liang X, Zhang Y, Wang JX, Wang LF, Huang WR, Tang X. Intravitreal ranibizumab injection at the end of vitrectomy for diabetic vitreous hemorrhage (Observational Study). Med (United States). 2019;98(20).

Gupta B, Sivaprasad S, Wong R, Laidlaw A, Jackson TL, McHugh D, et al. Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: The DRIVE UK Study. Eye. 2012;26(4):510–6.

Balakrishnan D, Jain B, Nayaka A, Rani PK, Mukundaprasad V, Jalali S. Role of Tamponade in Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage. Semin Ophthalmol. 2017;32(4):488–91.

Lin HC, Yang CH, Yang CM. Visual outcomes of vitrectomy for polypoidal choroidal vasculopathyrelated breakthrough vitreous haemorrhage. Eye. 2014;28(7):797–807.

Mahalingam P, Topiwalla TT, Ganesan G. Vitreous rebleed following sutureless vitrectomy: incidence and risk factors. Indian J Ophthalmol. 2018;66:55861.

Shi L, Huang YF. Postvitrectomy diabetic vitreous hemorrhage in proliferative diabetic retinopathy. J Res Med Sci. 2012;17(9):865–71. 21. Kim JH, Kim JW, Kim CG, Lee DW. Long-term Clinical Course after Vitrectomy for Breakthrough Vitreous Hemorrhage Secondary to Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy. Sci Rep. 2020;10(1):1–9.

Authors

Astriviani Switania
Elvioza
Waldensius Girsang
Soefiandi Soedarman
Referano Agustiawan
Switania, A. ., Elvioza, Girsang, W. ., Soedarman, S. ., & Agustiawan, R. . (2024). Vitrectomy for the Management of Vitreous Hemorrhage : Clinical Characteristics and Surgical Outcomes. Ophthalmologica Indonesiana, 49(S2). https://doi.org/10.35749/kd6h2266

Article Details

How to Cite

Switania, A. ., Elvioza, Girsang, W. ., Soedarman, S. ., & Agustiawan, R. . (2024). Vitrectomy for the Management of Vitreous Hemorrhage : Clinical Characteristics and Surgical Outcomes. Ophthalmologica Indonesiana, 49(S2). https://doi.org/10.35749/kd6h2266