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STRICT POSTURING WITH OR WITHOUT BILATERAL PATCHING FOR POSTERIOR VITREOUS DETACHMENT–RELATED VITREOUS HEMORRHAGE

van Etten, PETER G. MD*; van Overdam, Koen A. MD*,†; Reyniers, Rudolf MD*; Veckeneer, Marc PhD*,†; Faridpooya, Koorosh MD*,†; Wubbels, René J. PhD; Manning, Sonia FRCSI (Ophth)*; La Heij, Ellen C. PhD*,†; van Meurs, Jan C. PhD*,†

doi: 10.1097/IAE.0000000000002561
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Purpose: To determine whether bilateral patching with posturing is superior to posturing alone in visualizing the superior retina in suspected posterior vitreous detachment (PVD)–related vitreous hemorrhage (VH).

Methods: Prospective randomized controlled trial: 80 patients with fundus-obscuring VH due to suspected retinal tear were randomized to strict posturing and bilateral patching overnight (Treatment A, 40 patients) or posturing (Treatment B, 40 patients).

Primary outcome: Visualization of ≥4 clock hours superior retina. Secondary outcome measures: laser treatment, vitrectomy rate, and retinal detachment within 12 months.

Results: Intention-to-treat analysis: In 38/40 (95%) with Treatment A and 32/40 (80%) with Treatment B, the confirmed diagnosis was PVD-related VH. Visibility of the superior retina for all patients: 29/40 (73%) after Treatment A and 21/40 (53%) after Treatment B (P = 0.07). Subgroup analysis for confirmed PVD-related VH; visibility of the superior retina: 29/38 (76%) after Treatment A and 15/32 (47%) after Treatment B (P = 0.01). In subgroup analysis, vitrectomy rate within 12 months was 61% (Treatment A) and 53% (Treatment B) (P = 0.63). Retinal detachment: eight patients after each treatment.

Conclusion: In patients with suspected PVD-related VH, overnight bilateral patching was not superior to posturing alone in superior retina visualization, but in a post-hoc analysis of patients with confirmed PVD-related VH, bilateral patching was superior.

In patients with suspected posterior vitreous detachment–related vitreous hemorrhage, overnight patching in addition to posturing was not superior to posturing alone in superior retina visualization, but it was superior in patients with confirmed posterior vitreous detachment–related vitreous hemorrhage. Vitrectomy rate was equal during 1-year follow-up.

*Department of Vitreoretinal Surgery, Rotterdam Eye Hospital, Rotterdam, The Netherlands; and

Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.

Reprint requests: Peter G. van Etten, MD, Department of Vitreoretinal Surgery, Rotterdam Eye Hospital, Schiedamse Vest 180, 3011 BH Rotterdam, The Netherlands; e-mail: p.vanetten@oogziekenhuis.nl

Paper presented at Euretina, Barcelona, Spain, September, 2017; Dutch Ophthalmic Congress (NOG), Groningen, Netherlands, March, 2018; Club Jules Gonin, Jersey, United Kingdom, July, 2018.

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.