Etiological Spectrum and Visual Outcomes of Spontaneous Vitreous Hemorrhage.

Abstract

Objectives: To evaluate the age-related etiological spectrum and visual outcomes of patients presenting with spontaneous vitreous hemorrhage (VH) at a tertiary eye emergency department.

Methods: This single-center retrospective cohort study reviewed the medical records of 55,107 patients who presented to a tertiary referral hospital between January 2018 and December 2024. A total of 804 eyes of 804 patients with a first episode of spontaneous vitreous hemorrhage and at least 12 months of follow-up were included. Etiology was determined by clinical examination, imaging methods, and diagnostic pars plana vitrectomy (PPV) when required. Patients were categorized into pediatric (<18 years), adult (18-65 years), and elderly (>65 years) groups. Best-corrected visual acuity (BCVA) at presentation and at 12-month follow-up was analyzed. Visual outcomes were compared between the early (≤3 months) and delayed (>3 months) vitrectomy groups.

Results: The incidence of spontaneous VH among emergency presentations was 1.46%. Male patients constituted 60.57% of the cohort. Retinopathy of prematurity was the most common etiology in pediatric patients, whereas proliferative diabetic retinopathy predominated in the adult and elderly groups. Mean BCVA improved from 1.54±0.63 logMAR at presentation to 0.38±0.39 logMAR at 12 months (p<0.001). Significant visual improvement was observed in all age groups (p<0.001). Diagnostic PPV was performed in 27% of eyes. Visual gain was greater in the early vitrectomy group than in the delayed vitrectomy group (0.58±0.25 vs 0.44±0.31 logMAR; p=0.02).

Conclusion: The etiological spectrum of spontaneous VH varies according to age. Significant visual improvement can be achieved with appropriate medical and surgical treatment. Early PPV in selected cases may provide superior visual recovery compared with delayed intervention.