title: Early Vitrectomy for Spontaneous, Fundus-Obscuring Vitreous Hemorrhage.
abstract: OBJECTIVE
  To examine the visual outcomes of early intervention in the setting of fundus-obscuring vitreous hemorrhage (VH) presumed to be due to posterior vitreous detachment.
  
  
  METHODS
  Retrospective comparative case series.
  
  
  METHODS
  All eyes that presented with a fundus-obscuring VH, defined as vision of 20/400 or worse and requiring a B-scan at presentation from 2003 to 2013, were evaluated. Eyes with any history of retinopathy, macular degeneration, recent trauma, presentation greater than 2 weeks after onset of symptoms, or follow-up of less than 2 months were excluded. The main outcome measure studied was final best-corrected visual acuity (BCVA) as dependent on the time to surgery.
  
  
  RESULTS
  Ninety-two eyes met inclusion criteria with a mean follow-up of 490 days. Initial BCVA was logMAR 2.218 (Snellen equivalent 20/3000-20/4000, range 20/400-light perception); final BCVA was 0.318 (Snellen equivalent of 20/40-20/50, range 20/20-light perception, P < .001). Fifty-six patients (60.8%) had either a retinal tear or a retinal detachment. Patients who underwent surgery within 1 week had no significant improvement over all others; however, a significant improvement was found when comparing early vs delayed surgery groups (P < .05). There was a significantly increased risk of developing a macula-off retinal detachment in patients who did not undergo surgery within 1 week of presentation.
  
  
  CONCLUSIONS
  Early surgical intervention results in similar visual outcomes compared to a conservative approach. However, early intervention significantly reduces the incidence of severe vision loss related to macula-involving retinal detachment. This study highlights the importance of close follow-up given the high risk of retinal detachment in fundus-obscuring vitreous hemorrhage.
authors.affiliation: Washington National Eye Center, Washington Hospital Center, Washington, DC; The Retina Group of Washington, Fairfax, Virginia. Electronic address: melamudalex@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamud
authors.affiliation: Washington National Eye Center, Washington Hospital Center, Washington, DC; Department of Ophthalmology, Georgetown University Hospital, Washington, DC.
authors.forename: Hubert
authors.initials: H
authors.lastname: Pham
authors.affiliation: Washington National Eye Center, Washington Hospital Center, Washington, DC; Department of Ophthalmology, Georgetown University Hospital, Washington, DC.
authors.forename: Zoey
authors.initials: Z
authors.lastname: Stoumbos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D014823:Vitreous Hemorrhage / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*