Vitreous Hemorrhage due to Posterior Vitreous Detachment: Incidence of Retinal Detachment and Spontaneous Clearance during observation

PURPOSE: To investigate the natural course of vitreous hemorrhage (VH) due to posterior vitreous detachment (PVD).

DESIGN: Retrospective chart review.

SUBJECTS: Consecutive patients with vitreous hemorrhage due to presumed posterior vitreous detachment between 1/1-2017 and 31/12-2021. Patients were followed conservatively.

METHODS: Patients with first episode of VH at a large eye hospital were included retrospectively through review of medical charts. Patients with a history of proliferative diabetic retinopathy, retinal venous occlusion or wet age-related macular degeneration were excluded.

MAIN OUTCOME MEASURES: Patients were followed for a minimum of two years until one of the following outcomes occurred: spontaneous VH clearing, rhegmatogenous retinal detachment (RRD), vitrectomy for persistent VH, or referral to a medical retinal service.

RESULTS: We included 366 patients (366 eyes); mean age: 65.2 years (SD 10.8), 42.9% women. VH obscured the fundus in 295 (80.6%) eyes. VH cleared spontaneously in 227 (62%), while RRD occurred in 61 (17%). Median time to RRD was 15 days (IQR: 8; 22). The risk of retinal detachment was significantly higher in men (Hazard Ratio (HR): 2.90 [1.64-5.12], p < 0.001) compared to women. Older patients exhibited a lower risk of RRD, HR 0.27 [95% CI, 0.13-0.59], p <0.001) in the 65-73 years age group, and HR 0.25 [95% CI, 0.10-0.63], p = 0.003) in the 73-94 years age group. Spontaneous clearing was associated with the density of vitreous hemorrhage. After 60 days, only 48% of the eyes cleared spontaneously. A total of 36 eyes did not clear spontaneously, requiring vitrectomy after a median duration of 98 days [62.75; 140.75].

CONCLUSION: This study demonstrates that vitreous hemorrhage presumed secondary to PVD showed great variability but generally took several months to clear, with 62% resolving spontaneously. However, 17% developed RRD; the majority during the first three weeks. Male gender and young age increased RRD risk. These findings highlight the importance of vigilant monitoring during the early phase and indicate that individual patients' characteristics may guide management strategy. Further prospective studies are warranted to refine risk stratification and optimize management protocols in this patient population.