Vitreous hemorrhage in infants

P. J. Ferrone and E. de Juan Jr
Department of Ophthalmology, Duke University Eye Center, Durham, NC.

OBJECTIVE: To evaluate the efficacy of early intervention with vitrectomy for dense, nonclearing, infantile vitreous hemorrhage. DESIGN: Case series. SETTING: Referral practice at a major university hospital eye center. PATIENTS: Consecutive, referred sample of six patients (< 1 year old) with dense vitreous hemorrhages. The causes of the vitreous hemorrhages were varied. Follow-up was from 8 months to 15 months, with an average of 10 months. INTERVENTIONS: Three-port, pars plana, complete posterior vitrectomies were performed. MAIN OUTCOME MEASURES: Improved visual acuity postoperatively and frequency of complications. RESULTS: Complications of the infantile vitreous hemorrhage included traction retinal detachment (two of six), epiretinal membrane formation (one of six), pigmentary retinopathy (four of six), strabismus (two of six), large anisometropic myopia (two of six), and occlusion amblyopia (three of six). These serious complications occurred as early as 5 weeks after the onset of the vitreous hemorrhage. Iatrogenic retinal dialyses, which occurred in two of six patients, were successfully treated. Marked to moderate visual improvement was noted in five of six patients. CONCLUSIONS: Vitrectomy is an acceptable early therapy for infantile vitreous hemorrhage, and we recommend that vitrectomy be considered as early as 3 to 4 weeks after the onset of a dense, infantile, vitreous hemorrhage in an attempt to avert serious complications of the hemorrhage.