Vitreous Haemorrhage When Laser Panretinal Photocoagulation Has Not Achieved Regression of Neovascularization in Proliferative Retinopathy
Clinical scenario
Vitreous haemorrhage arising from neovascularization in the setting of proliferative retinopathy. The source of bleeding is retinal neovascularization driven by the underlying proliferative process — regression of that neovascularization is the primary clinical objective.
Previous treatment & escalation trigger
First-line management aims to achieve regression of neovascularization through laser panretinal photocoagulation, performed where possible through the residual haemorrhage. Intravitreal anti-VEGF agents may be used in the interim to induce regression until laser photocoagulation is feasible. When neovascularization regression — the defined treatment goal — is not achieved, the clinical situation warrants escalation to a further intervention.
Next-step approach
For vitreous haemorrhage that persists without clearing, a direct surgical approach to the vitreous is the indicated next step. The full protocol specifies the complete criteria, decision points, and procedural approach.
References
- If neovascularization from proliferative retinopathy is the cause, laser panretinal photocoagulation is performed, if possible through the residual hemorrhage, to cause regression of neovascularization.
- Vitrectomy is also indicated for nonclearing vitreous hemorrhage, neovascularization of the iris and/or angle, or ghost cell glaucoma.
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