To evaluate the role of vitrectomy for eyes with dense VH presumed secondary to CNV, as well as their clinical outcomes.Methods
Retrospective, consecutive case series from a single centre of 11 eyes of 11 patients over 2 years who underwent vitrectomy, and with no other identified ocular pathology e.g. diabetic retinopathy or trauma.Results
Visual acuity (VA) improved in 9 (82%) patients with mean logMAR VA change of 1.19 (+/- 0.69). Prior to vitrectomy, intravitreal anti-vascular endothelial growth factor (anti-VEGF) had been given to 2 patients; pneumatic displacement of submacular haemorrhage to 1 patient; and photodynamic therapy with verteporfin to 1 patient. There were no pre-existing retinal breaks found in all patients intraoperatively. Intraoperative complications include 1 posterior capsule rupture with anterior chamber intraocular lens insertion and 2 iatrogenic retinal breaks treated with laser. Angiography identified polypoidal choroidal vasculopathy in six, occult CNV in one and retinal pigment epithelium rip but no identifiable vascular lesion in one. Angiography was not done in three due to extensive disciform scarring. Lesions beyond the vascular arcade were found to have better prognosis. Recurrence of vitreous haemorrhage occurred in 2 patients.Conclusion
Vitrectomy for patients with dense VH and presumed CNV (most commonly PCV) was found to be useful to improve visual acuity, especially for lesions beyond the vascular arcade, although effect is limited. Vitrectomy also allows for subsequent retinal evaluation and angiography. The absence of pre-existing retinal tears is in agreement with the reported outcome that the pathophysiology of breakthrough VH does not involve retinal tears.