Vitreous hemorrhage of unknown origin in adult non-diabetic non-traumatic eyes: a retrospective analysis and the lessons we learn from it

Objective: To analyse the causes of vitreous hemorrhage (VH) of unknown origin in non-diabetic nontraumatic eyes and evaluate the results regarding the underlying cause and time of surgery. Methods and Analysis: Retrospective analysis of 125 eyes with a dense VH of unknown origin, who underwent vitrectomy at a varied time point. Preoperative and postoperative data were compared between the groups with the three major causes of VH as well as between the eyes with an early (≤5 days after presentation) and a late (>5 days after presentation) vitrectomy. Results: Most common causes of VH were retinal vessel occlusion (RVO; 39/125; 31.1%), retinal tears (36/125; 28.8%) and submacular hemorrhage (34/125; 27.2%). Postoperative visual acuity improved significantly in all eyes (2.14 vs. 1.04 logMAR, p<0.01) with better outcome in eyes with retinal tears. Early vitrectomy group had better functional outcome regardless of underlying cause (p=0.02). Final visual outcome correlated significantly with the underlying cause of VH (p<.001) and time to treatment in the retinal tear group (p<.001). Conclusion: We encourage performing early minimal invasive vitreoretinal surgery in cases of non-diabetic, non-traumatic VH. More than three of four of the cases are caused by retinal tear/retinal detachment, submacular hemorrhage and RVO. Early surgical treatment had better functional outcome on the longer run.