HAJ SLIMENE Mariem
To describe the clinical features and outcome of vitreous hemorrhage (VH) associated with ocular inflammatory conditions.
A retrospective case series of patients presenting with VH associated with uveitis from 2007 to 2020.
In total, 46 cases (56 eyes) of VH were identified over the study period, with a mean age of 27.5 years and a male to female ratio of 2.28. VH revealed the underlying inflammatory disorder in 45.7% of cases. The underlying mechanisms were ischemic retinal neovascularization (NV) (64.3%), inflammatory NV (26.8%) and vasoproliferative tumours (1.8%). Posterior uveitis was the most common form of uveitis (48.2%). Ocular tuberculosis was the main etiology followed by Behçet's disease, and idiopathic intermediate uveitis. Comparative study showed that VH secondary to inflammatory NV were more frequent in children, more associated with idiopathic intermediate uveitis, vitritis, ant snowballs and fern like capillaritis and had a better visual prognosis, while VH secondary to ischemic NV were more frequent in adults, more associated with posterior uveitis, vascular sheathing and retinal hemorrhages and had a worse visual prognosis. Therapeutic modalities included corticosteroids (71.1%), immunosuppressive systemic therapy (34.8%), anti-tuberculosis drugs (28.3%), scatter laser photocoagulation of retinal nonperfusion areas (50%), anti-VEGF intravitreal injections (25%), and vitrectomy (21%). The mean final visual acuity was 20/40 and was significantly higher in children and in the case of inflammatory neovessels (p=0.045 and p=0.007, respectively).
In this series, Tuberculosis, Behçet's disease and sarcoidosis are the main etiologies of inflammatory VH in adults. Idiopathic intermediate uveitis is the main etiology of VH complicating childhood uveitis.