Vitreous Haemorrhage from Proliferative Retinopathy Neovascularization — Next Step When Laser Panretinal Photocoagulation Fails to Achieve Regression

This protocol covers vitreous haemorrhage arising from neovascularization due to proliferative retinopathy, with no concurrent retinal detachment and no retinal break — specifically in cases where the prior treatment line has not achieved its target.

Clinical scenario

Neovascularization from proliferative retinopathy is the underlying cause. There is no concurrent retinal detachment and no retinal break. The initial approach targets regression of the neovascularization through laser panretinal photocoagulation applied through the residual haemorrhage, with intravitreal anti-VEGF agents used as interim therapy when laser is not immediately possible.

Escalation trigger — prior treatment did not reach its goal

Laser panretinal photocoagulation (and/or intravitreal anti-VEGF agents as interim therapy) was the first-line approach. When regression of retinal neovascularization is not achieved, this protocol defines the next management step.

Next-line approach (partial)

A surgical intervention is indicated. The appropriate timing of this intervention differs according to the patient's underlying systemic context. The complete criteria and sequencing are available in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

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.
Timing of vitrectomy depends on the underlying etiology.

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