This protocol covers the first-line management of vitreous haemorrhage when the underlying cause is neovascularization arising from proliferative retinopathy, in the specific setting where no concurrent retinal detachment and no retinal break are present.

Clinical Situation

Neovascularization from proliferative retinopathy is the identified source of haemorrhage. The absence of retinal detachment and retinal break defines the boundaries of this clinical scenario and shapes its management pathway.

Clinical Goals

Management aims for inferior settling of the vitreous haemorrhage and restoration of retinal visualization to allow adequate assessment of the posterior pole and superior retina.

Management Approach

The initial approach is observational and conservative, managed on an outpatient basis. It centres on specific activity and positional measures intended to encourage inferior settling of blood — the complete structured regimen is available via the protocol link below.

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.
Provided the retina is attached, observation is on an outpatient basis.
If the view to the posterior pole is blocked, limitation of activities and elevation of the head of the bed while sleeping may allow the blood to settle inferiorly and permit visualization of the superior retina where retinal breaks most commonly occur.

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Treatment of Vitreous Haemorrhage in Neovascularization from Proliferative Retinopathy Without Retinal Detachment or Break

References