title: Planned two-step vitrectomy for extremely large and thick subretinal hematoma.
abstract: OBJECTIVE
  To describe a new surgical strategy, planned two-step vitrectomy, for a large and thick subretinal hematoma involving 3 or more quadrants of the fundus. SURGICAL METHODS: In a first-step vitrectomy, a retinotomy was made in the posterior pole, after any vitreous hemorrhage had been removed. Following fluid-gas exchange with no laser photocoagulation around the retinotomy, patients took a face-down position for a few days to a week to facilitate subretinal hemorrhage movement to the vitreous cavity and anterior chamber. In a second-step surgery, the hemorrhage in the vitreous cavity and anterior chamber was washed out. The remaining subretinal hemorrhage was aspirated, and the retina was reattached with fluid-gas exchange and laser photocoagulation around the retinotomy.
  
  
  RESULTS
  The planned two-step vitrectomy was performed in 4 consecutive patients with large and thick subretinal hematomas involving 3 or more quadrants seen during a 3-year period. By a face-down position after the first-step vitrectomy, subretinal hemorrhage moved to the vitreous cavity and anterior chamber. The remaining subretinal hemorrhage in a smaller quantity could be easily removed, leading to retinal reattachment in the second-step surgery.
  
  
  CONCLUSIONS
  The planned two-step vitrectomy is a safer and more effective procedure for removing a large quantity of subretinal hemorrhage in a shorter period of surgical time, compared with hemorrhage removal in a single vitrectomy.
authors.affiliation: Department of Ophthalmology, Okayama University Medical School, Okayama City, Japan. matsuot@cc.okayama-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Matsuo
authors.forename: F
authors.initials: F
authors.lastname: Shiraga
authors.forename: I
authors.initials: I
authors.lastname: Takasu
mesh_terms: D000368:Aged; D005260:Female; D005451:Fluorescein Angiography; D006406:Hematoma / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012166:Retinal Hemorrhage / Q000601:surgery*; D013459:Sulfur Hexafluoride / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D013459:Sulfur Hexafluoride