What is the management of subhyaloid hemorrhage (Vitreous hemorrhage)?

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From the Guidelines

Vitrectomy surgery is typically reserved for cases of subhyaloid hemorrhage with dense pre-macular subhyaloid hemorrhage, and recent advances have improved outcomes and decreased adverse events. The management of subhyaloid hemorrhage (vitreous hemorrhage) involves a step-wise approach, considering the severity and location of the hemorrhage.

  • For non-clearing vitreous hemorrhage, vitrectomy surgery is recommended, as it has shown improved outcomes if performed within 1 to 6 months of onset compared with later vitrectomy at 1 year 1.
  • Pre-operative anti-VEGF treatment may reduce the duration of surgery, the number of retinal breaks, and the amount of intra-operative bleeding, and pre-operative or intra-operative bevacizumab may reduce the incidence of post-operative vitreous hemorrhage 1.
  • Serial ultrasounds should be used to evaluate for possible retinal tear, tractional retinal detachment that threatens the macula, or rhegmatogenous retinal detachment.
  • Medical management includes controlling underlying conditions like diabetes, hypertension, or blood disorders that may have contributed to the hemorrhage, and patients should avoid anticoagulants if possible.
  • Pain management with acetaminophen may be needed, and patients should be advised to avoid strenuous activities that could exacerbate the condition.
  • Early intervention is particularly important in cases where the hemorrhage is thick or located in the macular area to prevent long-term visual complications from blood toxicity to the retina.
  • Recent advances, including endolaser and small-gauge instruments, have improved outcomes and decreased adverse events in vitrectomy surgery for vitreous hemorrhage 1.

From the Research

Management of Subhyaloid Hemorrhage

The management of subhyaloid hemorrhage, also known as vitreous hemorrhage, can be achieved through various methods, including:

  • Nd:YAG laser hyaloidotomy, a minimally invasive treatment option that creates an opening in the posterior hyaloid membrane to drain the subhyaloid hemorrhage into the vitreous cavity 2, 3, 4
  • Intravitreal injection of SF6 gas, which can help disperse the hemorrhage into the vitreous cavity and induce posterior vitreous detachment 5
  • Pars plana vitrectomy, which may be necessary in cases where Nd:YAG laser hyaloidotomy is unsuccessful or in cases with underlying retinal conditions such as proliferative diabetic retinopathy (PDR) 4

Treatment Outcomes

The outcomes of these treatments can vary, with some studies reporting:

  • Rapid improvement in visual acuity after Nd:YAG laser hyaloidotomy, with vision improving from 20/200 to 20/20 in one case 2
  • Improvement in visual acuity from hand motions to 20/40 after intravitreal injection of SF6 gas 5
  • Success rate of 86.4% for Nd:YAG laser hyaloidotomy, with vision improving from a median of 3/60 pre-operatively to 6/6 at 6 months follow-up 4

Complications and Considerations

Complications and considerations for these treatments include:

  • Vitreous body opacification, which can develop after Nd:YAG laser hyaloidotomy and requires close monitoring 2
  • Delayed reabsorption of the hemorrhage, which may require vitrectomy 2
  • Tractional detachment and epiretinal membrane formation, which can occur in cases with underlying retinal conditions such as Eales' disease 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Subhyaloid hemorrhage treated with SF6 gas injection.

Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye, 2004

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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