Management of unexplained haemorrhagic PVD at Southampton Eye Casualty Clinic

PurposeTo assess the management of unexplained haemorrhagic PVDs at the Eye Casualty Clinic and compare it with suggested management plans in the literature. Finally suggest possible changes which could improve outcomes.MethodsA retrospective review of patient electronic records at HICCS, e-Documents and MEDISOFT databases over a 5-month period (August 2014-December 2014). All patients attending eye casualty clinic with a diagnosis of a haemorrhagic PVD were included. Patients with pre-existing retinal neovascularisation or haemorrhagic ARMD and Macroaneurysms were excluded.ResultsThere were 43 patients recorded with unexplained haemorrhagic PVDs in 5 months. 28/43 (65.1%) patients were seen and Discharged at the Eye Casualty Clinic in Max 2 visits. The remaining 15/43 (34.9%) patients were referred to VR OPD for further review. Of these, 7/15 patients had a retinopexy performed prior to VR OPD visit. The patients were seen by different doctors every time and of varying clinical experience (SHO, SpR, Fellow, Associate Specialist, Locum Consultant).ConclusionsThe retinal break was missed in 3/8 (37.5%) of the patients presenting at the Eye Casualty Clinic with an unexplained haemorrhagic PVD and a break despite the presence of a good fundus view.A significant number of patients (28/43, 65.1%) were managed solely at the Eye Casualty Clinic effectively.All the patients that had a laser retinopexy were referred to the VR OPD in 2 weeks for a review.SuggestionsAll patients with unexplained haemorrhagic PVDs and no fundal view should be referred to the VR service the same day for possible early vitrectomyAll patients with no obvious retinal break and reasonable view of their fundus (unless having a very clear view) must be referred to the VR OPD within 1 week for a more detailed fundoscopy.