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Vitreous hemorrhage in infants
1Department of Ophthalmology, Duke University Eye Center, Durham, NC.
Insights
Early vitrectomy surgery can significantly improve vision in infants with dense vitreous hemorrhage. This intervention helps prevent serious complications like retinal detachment and amblyopia.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Infantile vitreous hemorrhage presents a significant challenge in pediatric ophthalmology.
- Dense, non-clearing hemorrhages can lead to severe visual impairment and long-term complications.
Observation:
- A case series evaluated six infants (<1 year old) with dense vitreous hemorrhages.
- The study assessed outcomes following three-port, pars plana, complete posterior vitrectomies.
- Follow-up ranged from 8 to 15 months, averaging 10 months.
Findings:
- Five out of six patients experienced marked to moderate visual improvement post-vitrectomy.
- Complications of infantile vitreous hemorrhage included retinal detachment, epiretinal membrane, pigmentary retinopathy, strabismus, myopia, and amblyopia.
- Iatrogenic retinal dialyses occurred in two patients but were successfully treated.
Implications:
- Vitrectomy is a viable early therapeutic option for infantile vitreous hemorrhage.
- Consideration for vitrectomy as early as 3-4 weeks post-hemorrhage onset is recommended.
- Early intervention aims to mitigate severe visual complications in affected infants.
Objective:
To evaluate the efficacy of early intervention with vitrectomy for dense, nonclearing, infantile vitreous hemorrhage.
Design:
Case series.
Setting:
Referral practice at a major university hospital eye center.
Patients:
Consecutive, referred sample of six patients (< 1 year old) with dense vitreous hemorrhages. The causes of the vitreous hemorrhages were varied. Follow-up was from 8 months to 15 months, with an average of 10 months.
Interventions:
Three-port, pars plana, complete posterior vitrectomies were performed.
Main Outcome Measures:
Improved visual acuity postoperatively and frequency of complications.
Results:
Complications of the infantile vitreous hemorrhage included traction retinal detachment (two of six), epiretinal membrane formation (one of six), pigmentary retinopathy (four of six), strabismus (two of six), large anisometropic myopia (two of six), and occlusion amblyopia (three of six). These serious complications occurred as early as 5 weeks after the onset of the vitreous hemorrhage. Iatrogenic retinal dialyses, which occurred in two of six patients, were successfully treated. Marked to moderate visual improvement was noted in five of six patients.
Conclusions:
Vitrectomy is an acceptable early therapy for infantile vitreous hemorrhage, and we recommend that vitrectomy be considered as early as 3 to 4 weeks after the onset of a dense, infantile, vitreous hemorrhage in an attempt to avert serious complications of the hemorrhage.