Non-diabetic and non-oculotraumatic vitreous haemorrhage treated by pars plana vitrectomy

Until the advent of pars plana vitrectomy, no efficient treatment for non-resorbing vitreous haemorrhage was at hand. Especially if the cause of the vitreous haemorrhage was not known, such as in most cases of non-diabetic and non-oculotraumatic vitreous haemorrhage, a lot of time often was lost by waiting for the resorption, because of the lack of any effective treatment modality.

All the cases (126) of non-diabetic and non-oculotraumatic vitreous haemorrhage treated with a pars plana vitrectomy for non-resorbing vitreous bleeding during a 15-year period were studied. Both the aetiology of the haemorrhage as well as the functional results have been tabulated. Except for the cases with a retinal detachment or a suspected retinal tear that were operated on immediately, 6 months were waited upon for spontaneous clearing.

One third of these haemorrhages was due to vascular lesions (32.5%), one third to "rhegmatogenous" disordes [retinal tears with (25.5%) or without (8%) retinal detachment and one third to a group of various diseases (13.5%)]. In this last group Terson syndrome (5.5%), age-related macular degeneration (13.5%) and presumed posterior vitreous detachment (12%) were most numerous. Functional results mainly depend upon the underlying cause of the vitreous haemorrhage. Visual acuity ranged from 20/40-20/20 in 100% of cases of Terson syndrome and posterior vitreous detachment, 80% of retinal tears, 27% of vascular disorders and 25% of retinal detachments. Vision below 20/400 was obtained in 76% of age-related macular degenerations, 51% of vascular lesions, 50% of retinal detachments and 10% of retinal tears.

Non-oculotraumatic and non-diabetic vitreous haemorrhages can be caused by a wide variety of diseases. If there is no tendency to spontaneous clearing a pars plana vitrectomy can be helpful by restoring visual function and by allowing treatment of the underlying disease in some cases. Most indications for vitrectomy are not urgent and one can wait for spontaneous clearing of the vitreous for about 6 months but with respect to retinal tears with or without retinal detachment no time should be lost. In these cases the vitrectomy should be done at once.