Vitreous hemorrhage

Vitreous hemorrhage (Vitreous hemorrhage)

1) Disease description (causes and symptoms)

• Definition·pathophysiology: This is a condition in which bleeding occurs from intraocular blood vessels in the retina, choroid, ciliary body, or other areas, and blood flows into the vitreous cavity. When blood is present in the vitreous, it interferes with light reaching the retina, resulting in reduced vision. Symptoms and prognosis vary depending on the location and amount of bleeding.
• Main causes: Neovascularization occurring in proliferative diabetic retinopathy (PDR), retinal vein occlusion, retinal vasculitis, choroidal neovascularization, retinal tears·retinal detachment, trauma, and others. Even normal blood vessels can bleed in cases of severe trauma or rapid posterior vitreous detachment.
• Main symptoms: Sudden-onset floaters (floating dots·web-like shapes), blurred vision or decreased visual acuity (in mild cases, only floaters in one eye may occur; in severe cases, only light perception may remain). Pain is usually not present (if pain occurs, another lesion should be suspected).

2) Treatment methods and precautions

• Conservative treatment
  • When there is a small amount of bleeding and no retinal abnormalities, wait for spontaneous absorption (several weeks to several months). Keeping the head elevated is recommended (so that the blood settles downward).
  • Systemic and ophthalmic treatment of the underlying disease (diabetes, vascular occlusion, etc.) should be provided concurrently.
• Medications and procedures
  • Depending on the cause, anti-VEGF injections (to inhibit neovascularization), laser photocoagulation (e.g., panretinal photocoagulation), and other treatments may be performed.
• Surgical treatment
  • Indications: When the bleeding is sufficiently dense that retinal examination is not possible, when it is nonabsorptive·prolonged, when retinal detachment is present, when recurrent rebleeding occurs, or when visual recovery is expected.
  • Representative surgery: Pars plana vitrectomy (PPV) — removal of the opacified vitreous, excision of blood, adhesions, and neovascularization, liquid-air or liquid-gas exchange when necessary, and hemostasis·laser treatment using instruments as needed.
  • After surgery, fluorescein fundus angiography may be performed to identify the source of the bleeding, followed by additional laser treatment or anti-VEGF administration.
• Complications and precautions
  • Possible complications include rebleeding, retinal detachment, progression of cataracts, secondary glaucoma (e.g., ghost cell glaucoma), infection (rarely occurring during surgery), and delayed vitreous absorption.
  • If you are taking anticoagulants or have a blood disorder, coordination with the attending physician is necessary (whether to discontinue or adjust treatment should be determined after an overall risk assessment).
  • Emergency situations: Immediate ophthalmology evaluation is recommended in cases of sudden severe vision loss, pain, or complete loss of light perception.
• Self-care
  • Actively manage underlying diseases (diabetes·hypertension, etc.), stop smoking·limit alcohol consumption, and avoid strenuous activities, lifting heavy objects, and vigorous exercise during the early recovery period.
  • Prevent trauma (protect the eyes) and undergo regular ophthalmic examinations.

3) Checklist before an outpatient visit (items to bring·organize, including example questions)

• Recommended items to prepare/bring
  • A list of all medications currently being taken (especially anticoagulants/antiplatelet agents, antidiabetic medications, etc.), including doses·administration times
  • Previous ophthalmic examination records (visual acuity tests, OCT, fundus photographs, fluorescein fundus angiography) and recent test results
  • Systemic diseases and test results (glycated hemoglobin HbA1c, blood pressure records, blood coagulation tests, etc.)
  • Timing and course of symptoms (when they began, sudden/gradual onset, one eye/both eyes, aggravating factors), and whether trauma occurred; photographs if available (if possible, photograph subjective visual field changes)
• Information that should be reported to the doctor in advance
  • Whether you recently received an eye injection (anti-VEGF), laser treatment, or ophthalmic surgery
  • Whether pain, vomiting, fever, or other systemic symptoms accompanied the bleeding
• Items to check yourself at the outpatient visit (notes that may be submitted to the doctor)
  • Vision (approximately how much you can see: normal, blurred, counting fingers, light perception, etc.)
  • Characteristics of the floaters (whether there are falling objects·spiderwebs·flashes of light)
  • Recent blood glucose·blood pressure control status

4) Examples of general questions to ask the doctor

• "Is my hemorrhage likely to be absorbed spontaneously? When is the recommended timing for observation versus surgery?"
• "What is the prognosis (visual recovery rate)? What are the risk factors?"
• "What are the benefits and risks (complications) of surgery (vitrectomy)?"
• "What activities should I avoid in daily life, and approximately how long will recovery take?"
• "Do I need to stop the anticoagulant (or antiplatelet agent) I am currently taking?"

5) Examples of disease-specific questions

• "If diabetic retinopathy is suspected as the cause, which treatment do you recommend first: anti-VEGF injections or panretinal photocoagulation (laser)?"
• "If retinal detachment findings (or a retinal tear) are suspected, how long can surgery (vitrectomy·retinal repair surgery) be postponed?"