Etiology and surgical outcomes in non-resolving vitreous hemorrhage: A prospective study

Objectives: The aim of this study was to find out the etiology of non-resolving vitreous hemorrhage (VH) and find out its surgical outcome. Material and Methods: This is a prospective, interventional hospital-based study extending over 24 months. Patients presenting with non-resolving VH, who had undergone microincision vitrectomy were included in the study. Follow-ups were done up to one 1 year for cases who required more than one intervention and at sixth week for final visual acuity. Results: Around 61 eyes of 59 patients with non-resolving VH were studied within a two-year study period (January 2018 to December 2019). The sample size calculated was 55 or more cases with a prevalence of 0.005. The data followed a normal distribution. Male: Female ratio was 48:11. Right eye: Left eye ratio was 41:20. Mean age of presentation for males was 50.60 ± 15.01 years and for females was 54.27 ± 8.55 years. Dimness of vision was the main presenting complaint in 81.96% ( n = 50 eyes), who had presented in a mean duration of 67.96 ± 79.29 months since the symptoms. Diabetes mellitus was present in 45.7% patients ( n = 27), which was the major systemic cause of VH. Proliferative diabetic retinopathy was the most commonest ocular cause of VH, found in 26 eyes (42.6%). In non-insulin -dependent diabetes mellitus (NIDDM), 9 eyes (33.3%) presented with VH within 0-10 years and in insulin-dependent diabetes mellitus (IDDM), 6 eyes (22.2%) had presented within 11-20 years. Cataract was present in 19 eyes (31.1%). Other systemic causes of VH were hypertension 18.03% ( n = 11), coronary arterial disorder (CAD) and nephropathy 3.38% ( n = 2 each), and anemia, paraplegia, and thyroid disorder 1.69% ( n = 1 each). Other ocular causes of VH were branch retinal vein occlusion (BRVO) 18.03% ( n = 11 eyes), trauma 11.4% ( n = 7 eyes), incomplete posterior vitreous detachment (ICPVD) 6.55% ( n = 4 eyes), Eales periphlebitis and posterior vitreous detachment (PVD) with retinal detachment (RD) 3.27% ( n = 2 eyes each), pseudophakic RD, choroidal neovascular membrane (CNVM), old retinochoroiditis, Falciparum band, macroaneurysm, and central retinal vein occlusion (CRVO) each 1.63% ( n = 1 eye of each). Mean pre-operative visual acuity was 1.21 ± 0.44 and mean postoperative visual acuity was 0.66 ± 0.54 (logarithm of the minimum angle of resolution [logMAR]), which was highly significant ( P -value = 0.000 paired t -test). About 26.2% eyes ( n = 16) had intraocular pressure (IOP) spikes post operatively which were treated with anti- glaucoma drugs. Six (9.8%) of the patients had to undergo re-vitrectomy. Conclusion: Non-resolving VH can be one of the major causes of profound visual loss and can occur with variable pathologies at any age. Early intervention in the form of micro-incision vitrectomy helps to treat the condition with a very good visual outcome.