Abstract
Purpose. To analyze causes and prognosis of acute-onset preoperatively unknown origin vitreous hemorrhage (VH). Methods. This study included patients who underwent vitrectomy for acute-onset preoperatively unknown origin VH. The underlying causes of VH, which were identified after vitrectomy, were analyzed. And overall visual prognosis of unknown origin VH was analyzed. Risk scoring system was developed to predict visual prognosis after vitrectomy. Results. 169 eyes were included. Among these, retinal vein occlusion (RVO), retinal break, and age-related macular degeneration (AMD) were identified in 74 (43.8%), 50 (29.6%), and 21 (12.4%) patients, respectively. After vitrectomy, logMAR BCVA significantly improved from 1.93 ± 0.59 to 0.47 ± 0.71. However, postoperative BCVA in AMD eyes were significantly poorer than others. Poor visual prognosis after vitrectomy was associated with old age, poor preoperative vision in both eyes, and drusen in the fellow eye. Conclusions. RVO, retinal break, and AMD are the most common causes of acute-onset preoperatively unknown origin VH and the most common causes of VH change with age. The visual prognosis of unknown origin VH is relatively good, except among AMD patients. Older patients with poor preoperative BCVA in both eyes and patients with AMD in the fellow eye are at a higher risk of poor visual prognosis following vitrectomy.
Highlights
The annual incidence of acute-onset vitreous hemorrhage (VH) in the general population is 7 cases per 100,000 persons [1]
Little is known about the causes and visual prognosis of acute-onset VH of preoperatively unknown origin
Most cases of acute-onset VH are caused by proliferative diabetic retinopathy (PDR), trauma, retinal break, proliferative retinopathy after retinal vein occlusion (RVO), or posterior vitreous detachment without retinal detachment [2,3,4,5,6]
Summary
The annual incidence of acute-onset vitreous hemorrhage (VH) in the general population is 7 cases per 100,000 persons [1]. The causes of VH include proliferative diabetic retinopathy (PDR), trauma, retinal break, proliferative retinopathy after retinal vein occlusion (RVO), and posterior vitreous detachment without retinal detachment [2,3,4,5,6]. The visual prognosis of VH caused by retinal break, posterior vitreous detachment, and branch RVO is relatively good [4, 6,7,8,9,10]. The visual prognosis of VH secondary to PDR and exudative age-related macular degeneration (AMD) is poor due to recurrent VH, tractional retinal detachment, and submacular hemorrhage [11,12,13,14]. In cases of VH caused by retinal neovascularization due to diabetic retinopathy or RVO, peripheral laser photocoagulation can regress the abnormal vessels, which may lead to VH
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