Early vitrectomy for fundus-obscuring dense vitreous haemorrhage from presumptive retinal tears

Dhingra, Narendra; Pearce, Ian; Wong, David

doi:10.1007/s00417-006-0278-6

Cited by 21 publications

(12 citation statements)

References 16 publications

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“…Although it is standard practice to offer PPV for patients with persistent non-clearing vitreous hemorrhage, 2 , 3 there is no consensus about the management of acute FOVH with no identifiable retinal tears and detachment on U/S. Traditionally, a conservative approach has been recommended, as there is a significant possibility of spontaneous clearance.…”

Section: Discussionmentioning

confidence: 99%

“…Although the medical and ocular history (eg, known PDR) may suggest the underlying cause of FOVH, B-scan ultrasound (U/S) is the only investigation available currently to assess the integrity of the posterior segment. Recent publications have recommended early pars plana vitrectomy (PPV) in cases with FOVH presumed to be resulting from retinal tears and detachments, irrespective of the U/S findings 2 , 3 relating to the limited sensitivity of ultrasonography in detecting retinal breaks. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Sandinha¹,

Kotagiri²,

Owen³

et al. 2017

OPTH

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PurposeTo assess the accuracy of B-scan ultrasound (U/S) in diagnosing cases of acute fundus obscuring vitreous hemorrhage (FOVH) using a standardized scan protocol and dedicated ophthalmic ultrasonographer.MethodsConsecutive patients presenting with acute FOVH of unknown cause, between January 2013 and December 2014, were prospectively recruited. Patients underwent a scan performed by a dedicated ultrasonographer, utilizing a systematic scan sequence and using an ocular specific U/S device. The U/S findings were compared to the findings during vitrectomy or after spontaneous hemorrhage clearance.ResultsFifty-eight eyes (58 patients) were included. An underlying rhegmatogenous retinal detachment (RRD) and retinal tears without RRD were reported in nine and 14 patients, respectively. Nineteen of these patients underwent vitrectomy, and the other four underwent laser retinopexy or cryopexy alone. An additional six patients with suspected but uncertain retinal tears underwent vitrectomy, during which tears were confirmed in three, two had retinal vessel avulsions, and one had retinal new vessels. There was “complete” agreement between the B-scan findings and clinical findings in 78% of patients, “partial” agreement in 19%, and agreement was not tested in 3%. When the agreement was “partial”, the disagreements did not affect patient management. The sensitivity was 100% for the detection of RRD, and for the detection of new retinal tears in patients without retinal detachment.ConclusionB-scan U/S scan was highly sensitive in identifying the pathology in acute FOVH. Our results show an improvement from previously reported results, likely related to the standardized scan protocol and dedicated ophthalmic ultrasonographer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Sandinha¹,

Kotagiri²,

Owen³

et al. 2017

OPTH

View full text Add to dashboard Cite

show abstract

“…Some authors have suggested that because of the risk of severe vision loss early vitrectomy may be considered. 14,15 Nevertheless actual practice patterns vary and include conservative management with serial office based examination, vitrectomy surgery or some combination of the two. Previous studies on this topic have been mostly descriptive.…”

Section: Discussionmentioning

confidence: 99%

“…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 two 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.…”

Section: Introductionmentioning

confidence: 98%

Early Vitrectomy for Spontaneous, Fundus-Obscuring Vitreous Hemorrhage

Melamud

Pham

Stoumbos

2015

American Journal of Ophthalmology

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“…Surgical management of vitreous hemorrhage with small-gauge vitrectomy is an accepted treatment with a low risk of complications. 13,15,16 Improvements in surgical technique and instrumentation make this a good option for patients requiring faster visual recovery and allows for rapid diagnosis. Given the advances in vitreoretinal surgery that have occurred over the last several years, the risk–benefit profile for surgical intervention may be changing.…”

Section: Introductionmentioning

confidence: 99%

Early Versus Delayed Vitrectomy for Nondiabetic Vitreous Hemorrhage

Connors

Shah

Blinder

et al. 2018

Journal of VitreoRetinal Diseases

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To analyze the surgical and visual outcomes in patients who underwent early versus delayed vitrectomy for dense nondiabetic, nonvascular vitreous hemorrhage from undetermined cause. Methods: A retrospective, consecutive series evaluating all patients with a preoperative diagnosis of nondiabetic vitreous hemorrhage treated surgically at The Retina Institute over the past 5 years. Vitreous hemorrhage had to be described as dense, with first-order vessels not visualized on funduscopic examination. Exclusion criteria included a diagnosis of diabetes mellitus, retinal vascular disease, any prior intraocular surgery other than cataract extraction, or any previously diagnosed ocular conditions. A total of 275 patients and 286 eyes were evaluated, with 52 patients and 52 eyes meeting inclusion criteria. Surgical treatment was with standard pars plana vitrectomy. Results: Of the 52 eyes that met inclusion criteria, 32 (61.5%) were found to have at least 1 retinal break. Sixteen eyes (30.1%) had a rhegmatogenous retinal detachment. Mean time from diagnosis of the vitreous hemorrhage to surgical intervention was 15 days (range, 0-78 days). Early vitrectomy was defined as surgical intervention within 10 days of diagnosis, while late vitrectomy was defined as surgical intervention following 10 days. Of eyes that were found to have a retinal detachment, 75% were phakic and 25% were pseudophakic. Final postoperative visual acuity in the early surgery cohort was 20/66, while in the late surgery cohort was 20/89, which did not achieve statistical significance (P ¼ .67). Conclusion: A significant percentage of patients with retinal detachment were phakic at the time of vitreous hemorrhage (75%) as compared to pseudophakic. Data from the largest series to date indicate that in phakic patients with dense hemorrhage, the risk of retinal detachment is high and should prompt consideration for more urgent surgical intervention.

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Early vitrectomy for fundus-obscuring dense vitreous haemorrhage from presumptive retinal tears

Cited by 21 publications

References 16 publications

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Accuracy of B-scan ultrasonography in acute fundus obscuring vitreous hemorrhage using a standardized scanning protocol and a dedicated ophthalmic ultrasonographer

Early Vitrectomy for Spontaneous, Fundus-Obscuring Vitreous Hemorrhage

Early Versus Delayed Vitrectomy for Nondiabetic Vitreous Hemorrhage

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