Posterior retinal breaks as a cause of vitreous hemorrhage in diabetes.
OBJECTIVE
To describe posterior retinal breaks as a cause of vitreous hemorrhage in diabetic patients.


METHODS
In two institutional practices, six posterior retinal breaks were identified in five eyes of five diabetic patients with vitreous hemorrhage. All eyes underwent fundus photography and fluorescein angiography. Four eyes received barrier photocoagulation. The outcome measures included retinal nonperfusion, proximity to retinal vessels, and progression to retinal detachment.


RESULTS
All six posterior breaks were in areas of retinal ischemia. No eyes had neovascularization. Three breaks had a bridging vessel, and three were in a paravascular location. One untreated eye had progression to a retinal detachment.


CONCLUSIONS
The differential diagnosis for vitreous hemorrhage in diabetic patients should include posterior retinal breaks, particularly in the absence of proliferative disease. These breaks are paravascular, are located in areas of retinal ischemia, and may involve avulsed bridging vessels. We suggest treatment with barrier rather than panretinal photocoagulation.
From the *Department of Ophthalmology, University of California at San Francisco, San Francisco, California; and the †California Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Stanford, California.
Thomas N
TN
Hwang
Darius M
DM
Moshfeghi
Mark S
MS
Blumenkranz