Retinal Tears in Fundus-obscuring Vitreous Hemorrhages of Unknown Cause: Risk Factors and Surgical Outcomes

Purpose: To identify factors associated with retinal tears in eyes presenting with fundus-obscuring vitreous hemorrhage (FOVH) of unknown cause and to evaluate surgical findings and visual outcomes following pars plana vitrectomy (PPV).Methods: This retrospective study included patients who underwent 23-gauge or 25-gauge PPV for acute-onset FOVH, defined as a dense vitreous hemorrhage obscuring both the posterior pole and peripheral retina across at least three quadrants with a best-corrected visual acuity (BCVA) of counting fingers or worse at presentation.Etiologies of FOVH were identified intraoperatively, and subsequent analyses focused on the prevalence, clinical characteristics, and surgical outcomes of eyes diagnosed with retinal tears.Results: Among the 8 9 eyes in cluded, retinal tears were the most common etiology (38.2%), followed by retinal vascular occlusion (27.0%), and polypoidal choroidal vasculopathy (13.5%).Eyes with retinal tears were significantly younger (57.2 vs. 67.9years, p <0.001) and less likely to have diabetes (5.9 vs. 41.8%,p <0.001) compared with those without retinal tears.In a multivariate analysis, younger age (p < 0.001) and absence of diabetes (p = 0.007) were independent predictors of retinal tears.Among eyes with retinal tears, the mean duration from symptom onset to surgery was 9.2 days.Most eyes (67.6%) had a single tear, and in 79.4%, the largest tear was in the superior quadrant.No cases of macular-off retinal detachment or proliferative vitreoretinopathy were observed.At final follow-up, 82.4% of the eyes achieved a BCVA of 20/20, with no cases of reoperation.Conclusions: Retinal tears are commonly identified intraoperatively in eyes presenting with FOVH, with younger age and absence of diabetes significantly associated with their presence.Despite delayed surgery, favorable anatomical and visual outcomes were achieved.Given the frequent localization of tears in the superior retina, careful peripheral inspection during vitrectomy is essential for detecting treatable pathology.