Planned two-step vitrectomy for extremely large and thick subretinal hematoma

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 fluid-gas exchange with no laser photocoagulation around the retinotomy, patients took a face-down position for a few days to a week to facilitate subretinal hemorrhage movement to the vitreous cavity and anterior chamber. In a second-step surgery, the hemorrhage in the vitreous cavity and anterior chamber was washed out. The remaining subretinal hemorrhage was aspirated, and the retina was reattached with fluid-gas exchange and laser photocoagulation around the retinotomy. Results: The planned two-step vitrectomy was performed in 4 consecutive patients with large and thick subretinal hematomas involving 3 or more quadrants seen during a 3-year period. By a face-down position after the first-step vitrectomy, subretinal hemorrhage moved to the vitreous cavity and anterior chamber. The remaining subretinal hemorrhage in a smaller quantity could be easily removed, leading to retinal reattachment in the second-step surgery. Conclusions: The planned two-step vitrectomy is a safer and more effective procedure for removing a large quantity of subretinal hemorrhage in a shorter period of surgical time, compared with hemorrhage removal in a single vitrectomy.