Vitreous Hemorrhage and Other Vitreous Opacities

This chapters discusses the technique, pit falls, and surgical tips for performing pars plana vitrectomy in the presence of dense vitreous opacities. Vitreous hemorrhage (VH) is one of the most common types of significant vitreous opacities seen in clinical practice. It can be caused by a variety of factors, including trauma, retinal vascular disorders, and posterior vitreous detachment (PVD). One of the important steps in managing vitreous hemorrhage is identifying the underlying cause. Fundus obscuring VH occurring secondary to acute PVD requires more urgent management than those secondary to retinal vascular diseases. Certain clues in history and examination are helpful in reaching the diagnosis and proper management. The surgical technique of pars plana vitrectomy in the presence of vitreous opacities is similar to that for other vitreoretinal surgery procedures. However, certain difficulties such as visualization of infusion cannula, retrolenticular hemorrhage, and presence of concomitant retinal detachment can be encountered during surgery. The surgeon must take these factors into account when planning for the surgery. With careful surgical technique, most patients with VH can achieve good surgical outcomes.