2009-07: Posture or Patching (PoP). Accelerated clearing of the media with massive vitreous hemorrhage and suspected retinal tear.
About 30-40% of the cases of vitreous hemorrhage are, supposedly, caused by posterior vitreous detachment (PVD) and retinal breaks. Diagnostics are complicated because a sufficiently dense vitreous hemorrhage obstructs the ophthalmologist's funduscopic inspection, and detection of a retinal tear by ultrasonographic examination is not sufficiently reliable. Therefore, the choice between instant vitrectomy, delayed vitrectomy or regular monitoring remains erratic. If no (initial) signs of retinal tear or detachment are observed, the patient is instructed to restrict physical activity and maintain an upright position, and to return for periodic evaluation. This observational policy may lead to a delay of treatment and an increased risk of developing retinal detachment which may result in a relatively poor outcome. It is conjectured that binocular occlusion with patches accelerates the clearing of an obscured fundus. With this randomized, open-label trial we investigate whether binocular patching in combination with posture adherence is superior to posture adherence alone in achieving visualization of the superior fundus quadrants or not. We include patients with vitreous hemorrhage obstructing retinal visiblilty. The interventions are: instruction to maintain posture (group 1 & 2) and binocular patching (group 2).