Outcomes of Vitrectomy for Severe Vitreous Hemorrhage of Unknown Etiology

Ji Young Moon; Jong Seok Park

doi:10.3341/jkos.2014.55.7.1024

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Moon and Park: Outcomes of Vitrectomy for Severe Vitreous Hemorrhage of Unknown Etiology

Original Article

J Korean Ophthalmol Soc 2014;55(7):1024-1029.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.7.1024

Outcomes of Vitrectomy for Severe Vitreous Hemorrhage of Unknown Etiology

Ji Young Moon, MD, Jong Seok Park, MD, PhD

Department of Ophthalmology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea

Address reprint requests to Jong Seok Park, MD, PhD Department of Ophthalmology, Eulji General Hospital, #68 Hangeulbiseok-ro, Nowon-gu, Seoul 139-711, Korea, Tel: 82-2-970-8271, Fax: 82-2-970-8272, E-mail: jymoon@eulji.ac.kr

Received 15 November 2013 Revised 6 February 2014 Accepted 2 June 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the clinical course and outcomes of vitrectomy for severe vitreous hemorrhage of unknown etiology and to determine the primary cause of hemorrhage during the surgical process.

Methods

The medical records of patients who showed vitreous hemorrhage of Grade IV at their initial visit with no remarkable ophthalmologic or trauma history were reviewed retrospectively. All included patients underwent vitrectomy for severe vitreous hemorrhage for which a primary cause was not revealed before the surgery. The authors investigated the postoperative visual outcome, complications, and etiology of vitreous hemorrhage that was determined during the surgical process. We also analyzed the detailed intraoperative and postoperative funduscopic findings of patients with poor postoperative visual outcomes (BCVA < 20/200).

Results

Among the 50 eyes of 50 patients, the causes of vitreous hemorrhage included: branch retinal vein occlusion (48%), central retinal vein occlusion (16%), age-related macular degeneration (12%), retinal tear (8%), diabetic retinopathy (4%), rhegmatogenous retinal detachment (4%), Terson's syndrome (2%), Eales’ disease (2%) and unknown causes (4%). The mean best-corrected visual acuity (BCVA) before surgery was 2.17 ± 0.53 (log MAR) and it was recovered to 0.64 ± 0.58 (log MAR) 6 months after the surgery (p < 0.001). The branch retinal vein occlusion showed better visual outcome than other disease entities. On funduscopic examination of the patients with poor visual outcome whose postoperative BCVA was poorer than 20/200, macular ischemia, macular degeneration, macular edema, submacular hemorrhage, tractional retinal detachment (including macular), or optic nerve atrophy were verified.

Conclusions

After the vitrectomy for severe vitreous hemorrhage of unknown origin, pathologic findings of macular or irreversible optic nerve atrophy showed poor postoperative BCVA. Of all the causes of vitreous hemorrhage that were revealed after the surgery, branch retinal vein occlusion was the most common etiology of this condition and showed the most favorable visual outcome, comparatively.

Keywords: Retinal vein occlusion, Vitrectomy, Vitreous hemorrhage

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Table 1.

Baseline characteristic of the patients

Characteristics	Values
Number of eyes (patients)	50 (50)
Age (years)	60.2 ± 12.7
Sex (male/female)	31/19
Comorbidity (%)
Diabetic mellitus	12 (24)
Cardiovascular disease	4 (8)
Cerebrovascular disease	6 (12)
Preoperative BCVA (log MAR)	2.17 ± 0.53
Preoperative IOP (mm Hg)	18.2 ± 9.7
Number of eyes with cataract (%)	32 (64)
Number of eyes with RAPD (%)	34 (68)
Duration from diagnosis to surgery (days)	14.7 ± 9.2

Values are presented as mean ± SD.

BCVA = best corrected visual acuity; IOP = intraocular pressure;

RAPD = relative afferent pupillary defect.

Table 2.

Intraoperative diagnosis of severe vitreous hemorrhage and postoperative visual outcome according to etiology

Final diagnosis	No. of eyes (%)	Postoperative visual outcome (no. of eyes (%))
Final diagnosis	No. of eyes (%)	VA ≥ 20/200	VA < 20/200
BRVO(%)	24 (48)	22 (91.7)	2 (8.3)
CRVO(%)	8 (16)	5 (62.5)	3 (37.5)
ARMD (%)	6 (12)	2 (33.3)	4 (66.7)
Retinal tear (%)	4 (8)	4 (100)	0 (0)
Diabetic retinopathy (%)	2 (4)	0 (0)	2 (100)
RRD (%)	2 (4)	2 (100)	0 (0)
Terson's syndrome (%)	1 (2)	1 (100)	0 (0)
Eale's syndrome (%)	1 (2)	1 (100)	0 (0)
Unknown (%)	2 (4)	2 (100)	0 (0)
Total (%)	50 (100)	39 (78)	11 (22)

VA = visual acuity; BRVO = branch retinal vein occlusion; CRVO = central retinal vein occlusion; ARMD = age-related macular degeneration; RRD = rhegmatogenous retinal detachment.

Table 3.

Findings of patients with poor postoperative visual outcomes (BCVA < 20/200)

No.	Sex/Age (years)	Initial VA	Final VA (postop. 6 months)	Major cause of poor VA (postop. 6 months)	Final diagnosis
1	M/71	HM	CF 70 cm	Macular edema	BRVO
2	M/62	CF 50 cm	CF 70 cm	Macular degeneration	ARMD
3	F/55	HM	CF 50 cm	Macular ischemia	CRVO
4	M/74	LP (+)	CF 50 cm	Optic atrophy	ARMD
5	F/68	HM	HM	Macular ischemia	BRVO
6	M/79	HM	LP (-)	Submacular hemorrhage total RD	ARMD
7	M/63	HM	HM	Macular degeneration	ARMD
8	M/69	CF 70 cm	CF 70 cm	Macular edema	CRVO
9	M/54	HM	HM	Macular ischemia	CRVO
10	F/44	CF 70 cm	0.02	TRD (including macular)	DMR
11	M/60	HM	CF 30 cm	Submacular hemorrhage	DMR

BCVA = best corrected visual acuity; VA = visual acuity; Postop = post operation; HM = hand movement; CF = counting finger; LP = light perception; RD = retinal detachment; TRD = tractional retinal detachment; BRVO = branch retinal vein occlusion; ARMD = age-related macular degeneration; CRVO = central retinal vein occlusion; DMR = diabetic retinopathy.

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