Purpose: To describe a new surgical strategy, planned two-step vitrectomy,
for a large and thick subretinal hematoma involving 3 or more quadrants of
the fundus.
Surgical Methods: In a first-step vitrectomy, a retinotomy was made in the
posterior pole, after any vitreous hemorrhage had been removed. Following f
luid-gas exchange with no laser photocoagulation around the retinotomy, pat
ients took a face-down position for a few days to a week to facilitate subr
etinal hemorrhage movement to the vitreous cavity and anterior chamber. In
a second-step surgery, the hemorrhage in the vitreous cavity and anterior c
hamber was washed out. The remaining subretinal hemorrhage was aspirated, a
nd the retina was reattached with fluid-gas exchange and laser photocoagula
tion around the retinotomy.
Results: The planned two-step vitrectomy was performed in 4 consecutive pat
ients with large and thick subretinal hematomas involving 3 or more quadran
ts seen during a 3-year period. By a face-down position after the first-ste
p vitrectomy, subretinal hemorrhage moved to the vitreous cavity and anteri
or chamber. The remaining subretinal hemorrhage in a smaller quantity could
be easily removed, leading to retinal reattachment in the second-step surg
ery.
Conclusions: The planned two-step vitrectomy is a safer and more effective
procedure for removing a large quantity of subretinal hemorrhage in a short
er period of surgical time, compared with hemorrhage removal in a single vi
trectomy.