I saw a patient, non-diabetic, with acute diminuishing of visual acuity.
Notinhg to say about the anteroir segment. When i tried to inspecto the retina it was very hazy. I assumed it was a vitreous hemorhage, but then i saw cells in the anterior vitreous. And there was no way i could inspect the whole retina
If you have a VH, you often have cells in the anterior vitreous, so seeing cells there certainly does not rule that out.
Also remember that there are many other reasons that one can get a VH besides DM.
If they are blood cells the patient can wait a few days/weeks to clear the blood and the be reavaluated. If its tobacco dust its from a retinal tear an an imediate surgery has to be done.
Right??
If it's tobacco dust from a retinal tear, you would prefer to do laser rather than immediate surgery. However, it's tough to laser what you can't see.
Inspect the retina as well as you can. Could you see if it was flat? If not, do a B-scan. If the retina is flat, have the patient sleep with their head elevated, no reading, limited activity, and check again the next day. If you can't find a hole and the retina is flat, are you going to take the patient to the OR with all of its inherent risks just to find out
if there's a hole because you're not sure if it's tobacco dust or RBCs? I hope not.
I've seen patients with tears who, for a variety of reasons, couldn't be completely treated with laser immediately and did not progress to an RD. Obviously you want to do it as quickly as possible, but sometimes real life doesn't allow that to happen.
As for "immediate surgery", even that is far from set in stone. The traditional teaching with an RD is to "never let the sun set on a macula-on detachment". However, there's not a ton of strong evidence for that thinking, and many people now are more willing to schedule the patient for surgery the next day or, in some cases, even day after that for surgery. How that goes will depend on the retina staff in your department, and it's best to discuss the issue with them. Different staff within the same department may deal with it differently, so it's good to know how they each feel about it.
In this situation, obviously another thing you need to consider is an endogenous endophthalmitis. From what you said, the rest of the eye sounds quiet, so that obviously would be much less likely, but it's just something to keep in mind.