Clinical Outcomes and Predictors of Retinal Breaks in Patients With Vitreous Hemorrhage Secondary to a Posterior Vitreous Detachment

Abstract

Purpose: To characterize anatomic and functional outcomes in cases of hemorrhagic posterior vitreous detachment (PVD) and quantify predictors of retinal breaks to provide additional data points for treatment considerations and patient counseling. Methods: This was a retrospective case series of patients with PVD and vitreous hemorrhage (VH) that used electronic health record data dated from 2014 to 2025. Recorded data included demographics, extent of VH, baseline and final best-corrected visual acuity (BCVA), type of management, and number of retinal breaks over the course of follow-up. Logistic regression was used to assess independent predictors of retinal breaks. Results: This study included 79 participants. The median BCVA of patients with fundus-obscuring and nonobscuring VH improved from 20/800 and 20/25 at baseline to 20/30 and 20/20 by the end of follow-up, respectively (P < .001 for both). Thirteen participants experienced a retinal break, 10 of whom had occult breaks. Predictors of retinal breaks included fundus-obscuring VH (odds ratio [OR], 7.9; SE, 0.75; 95% CI, 1.8-34.2; P = .006; Nagelkerke R², 0.3) and a BCVA of 20/200 or worse (OR, 7.5; SE, 0.7; 95% CI, 1.9-29.4; P = .004; Nagelkerke R², 0.31). Conclusions: Patients with PVD and VH have favorable functional outcomes. In select cases, those with poor vision or fundus-obscuring VH may benefit from early surgical intervention given the heightened risk of occult retinal breaks.