Vitreous

With regard to the ciliary vitreous:

• Vitreous base avulsion does not require surgery unless accompanying complications (e.g., vitreous hemorrhage, retinal break/detachment) demand it (see Chap. 2.9).

• Hemorrhage is one of the most commonly encountered pathologies after a contusion: vitreous or retinal hemorrhages occur in up to three-fourths of contused eyes [8].3 In one study, 45% of eyes had accompanying retinal pathology, and 79% of eyes had a final visual acuity of worse than 20/40 [15]. Data from the USEIR are further proof that contusion-related vitreous hemorrhage must be considered a serious condition (see below). Unfortunately, it is common in clinical practice to:

- Observe eyes with vitreous hemorrhage if this was caused by contusion; the patient is usually advised to undergo ultrasonography every 3 months or so to "detect a retinal detachment in its earliest phase" or to "identify vitreous organization before PVR commences" (see Chap. 2.9).

- Perform vitrectomy only when either of these two conditions is recognized or the vitreous hemorrhage has not shown signs of spontaneous absorption for several months.

• A safer alternative to this conservative approach is early vitrectomy (i.e., within weeks and without waiting for the above-mentioned pathologies to occur). There are risks associated with observation (Table 2.10.1), even if the patient does rigorously adhere to the follow-up schedule.

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