Evaluation of Early Vitrectomy in Pre-macular Hemorrhage

Background: Pre-macular hemorrhage (PMH) is a vision-threatening condition caused by the accumulation of blood in the subhyaloid or sub-internal limiting membrane space, often due to systemic or ocular vascular events. If not promptly managed, prolonged contact between blood and retinal tissue can lead to irreversible photoreceptor damage and poor visual outcomes. Early surgical intervention through pars plana vitrectomy (PPV) has been proposed as a means to rapidly restore the visual axis and improve prognosis. The aim of the work: This work aimed To evaluate the efficacy and safety of early pars plana vitrectomy with hemorrhage evacuation and appropriate tamponade in patients presenting with premacular hemorrhage. Patients and Methods: This prospective interventional study included 30 patients (30 eyes) with premacular hemorrhage treated at Al-Azhar University Hospitals. All patients underwent early 23- or 25-gauge PPV within two weeks of symptom onset. Data collected included demographic details, systemic comorbidities, ocular history, visual acuity (VA), type and location of hemorrhage, tamponade agent used, and postoperative outcomes. Best-corrected visual acuity (BCVA) was assessed preoperatively, and at one and three months postoperatively. Complications were recorded. Results: The mean age was 51.5 ± 15.5 years; 60% were male. Diabetic retinopathy was the most common etiology (66.7%). Hemorrhages were predominantly subhyaloid (86.7%). Silicone oil was the most used tamponade (56.7%). Mean BCVA improved significantly from 0.0017 ± 0.0012 to 0.4 ± 0.2 at one month (p=0.001), with a slight decrease to 0.33 ± 0.2 at three months (p=0.001). Complications included cataract progression (26.7%), posterior capsule opacification (16.7%), and retinal tear (6.7%). Conclusion: Early PPV is an effective and safe intervention for premacular hemorrhage, offering significant visual improvement and rapid recovery with an acceptable complication rate.