Rhegmatogenous retinal detachment associated to vitreous hemorrhage. Role of primary vitrectomy?

Purpose The incidence of retinal break formation following acute posterior vitreous detachment is variously reported as occurring in between 8% to 15% of patients, associated up to 39% of the eyes with rhegmatogenous retinal detachment. Methods Retrospective review of noncomparative interventional case series and cases treated in our department Results The management of patients with fundus‐obscuring dense vitreous haemorrhage due to presumptive retinal tears advocates waiting for spontaneous resolution. Surgery is indicated only when a definite retinal tear or retinal detachment is identified. However, the degree of agreement between ultrasound and clinical findings, indicate retinal diagnosed and localized accurately in only 44% of eyes. Early vitrectomy for spontaneous dense fundus‐obscuring vitreous haemorrhage and posterior vitreous detachment seems safe. Rhegmatogenous retinal detachment with severe VH is associated with longer duration of preoperative haemorrhage, a higher incidence of severe PVR and worse visual outcome. An 75% incidence of retinal detachment was reported in eyes with a history of retinal detachment in the contralateral eye. Close follow‐up and aggressive surgical interventions are suggested in these patients. Conclusion Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus‐obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow‐up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.