Objective To investigate the effects and complications of the vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment. Methods Seventy-seven eyes of 69 cases undergoing vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment were analyzed retrospectively. Results (1) The postoperative visual acuity was enhanced significantly. (2) Complications during the operation in 11 eyes (14.3%): iatrogenic retinal break in 7 eyes, bleeding in 3 eyes and lens damage in 1 eye. (3) Postoperative complications in 20 eyes (26.0%): rebleeding in 14 eyes, elevated IOP in 6 eyes, retinal detachment in 5 eyes, hyphema in 2 eyes, and exudative membrane in anterior chamber in 1 eye. (4) The main long-term complication was cataract formation (9 eyes) and macular disorder (6 eyes). Conclusion Vitrectomy is an effective method to treat Eales′ disease with vitreous hemorrhage or traction retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 215-217)
ObjectiveTo investigate the risk factors of postoperative vitreous hemorrhage after minimal vitrectomy without endotamponade for proliferative diabetic retinopathy (PDR).MethodsFrom June 2015 to June 2017, 103 eyes of 103 patients with PDR diagnosed and underwent minimalvitrectomy in Henan Provincial People's Hospital were enrolled in the study. There were 58 males and 45 females, with the average age of 58.37±10.14 years and diabetes duration of 8.7±7.2 years. Baseline systemic parameters including sex, age, diabetes duration, hypertension, HbA1c, creatinine, whether received anticoagulants, ocular parameters including whether combined with vitreous hemorrhage, whether finished panretinal photocoagulation (PRP), whether received treatment of anti-VEGF, whether combined with iris neovascularization (NVI), lens status preoperatively, whether hypotony postoperatively and intraoperative parameters including whether disc neovascularization (NVD) bleeding, whether fibrovascular membrane (FVM) residual, laser points, whether combined with cataract phacoemulsification were identified by multivariate logistic regression analysis.ResultsTwenty-nine of 103 eyes (28.15%) developed PVH in 1 day to 6 months after surgery, with self absorption of 18 eyes and reoperation of 11 eyes. Univariate analysis showed there were significant differences in age (t=2.124, P=0.036), anti-VEGF(χ2=7.105, P=0.008), NVD bleeding (χ2=10.158, P=0.001) and FVM residual(χ2=8.445, P=0.004) between patients with and without postoperative vitreous hemorrhage. Sex (χ2=0.021, P=0.884), diabetes duration (t=0.87, P=0.386), hypertension (χ2=2.004, P=0.157), HbA1c (t=1.211, P=0.229), creatinine (t=0.851, P=0.397), preoperative oral anticoagulants (χ2=0.985, P=0.321), preoperative vitreous hemorrhage (χ2=0.369, P=0.544), PRP (χ2=1.122, P=0.727), NVI (χ2=2.635, P=0.105), lens status (χ2=0.172, P=0.679), hypotony postoperatively (χ2=1.503, P=0.220), laser points (χ2=1.391, P=0.238) and combined phacoemulsification surgery (χ2=0.458, P=0.499) were not associated with PVH. Multivariate logistic regression analysis revealed the more PVH appeared in younger (OR=1.065, P=0.009) and NVD bleeding (OR=6.048, P=0.001) patients.ConclusionYounger age and NVD bleeding are the important risk factors for PVH after minimal vitrectomy without endotamponade in PDR.
ObjectiveTo review the outcome of intravitreous anti-vascular endothelial growth factor (VEGF) treatment in patients with X-linked retinoschisis (XLRS) complicated with vitreous hemorrhage (VH). MethodsA retrospective clinical study. From March 1, 2016 to April 1, 2022, 18 patients (19 eyes) diagnosed with XLRS complicated with vitreous hemorrhage in Beijing Tongren Hospital, Capital Medical University of Eye Center were included. All the patients were male, with a median age of 7.05±3.8 years. Best corrected visual acuity (BCVA) and wide-angle fundus photography were performed in all the patients. BCVA was carried out using international standard visual acuity chart, and converted into logarithm of minimum resolution angle (logMAR) in statistics analysis. According to whether the patients received intravitreal injection of ranibizumab (IVR), the patients were divided into injection group and observation group, with 11 eyes in 10 cases and 8 eyes in 8 cases, respectively. In the injection group, 0.025 ml of 10 mg/ml ranibizumab (including 0.25 mg of ranibizumab) was injected into the vitreous cavity of the affected eye. Follow-up time after treatment was 24.82±20.77 months. The VH absorption time, visual acuity changes and complications were observed in the injection group after treatment. Paired sample t test was used to compare BCVA before and after VH and IVR treatment. Independent sample t test was used to compare the VH absorption time between the injection group and the observation group. ResultsLogMAR BCVA before and after VH were 0.73±0.32 and 1.80±0.77, respectively. BCVA decreased significantly after VH (t=－3.620, P=0.006). LogMAR BCVA after VH and IVR were 1.87±0.55 and 0.62±0.29, respectively. BCVA was significantly improved after IVR treatment (t=6.684, P＜0.001). BCVA records were available in 5 eyes before and after IVR, and the BCVA values after VH and IVR were 0.58±0.31 and 0.48±0.20, respectively, with no statistically significant difference (t=1.000, P=0.374). BCVA increased in 1 eye and remained unchanged in 4 eyes after treatment. BCVA records were available in 5 eyes before VH and after VH absorption in the 8 eyes of the observation group. LogMAR BCVA before VH and after VH absorption were 0.88±0.28 and 0.90±0.26, respectively, with no significant difference (t=－1.000, P=0.374). After VH absorption, BCVA remained unchanged in 4 eyes and decreased in 1 eye. The absorption time of VH in the injection group and the observation group were 1.80±1.06 and 7.25±5.04 months, respectively. The absorption time of VH was significantly shorter in the injection group than in the observation group, the difference was statistically significant (t=－3.005, P=0.018). Multivariate linear regression analysis showed that IVR treatment was significantly correlated with VH absorption time (B=－6.66, 95% confidence interval －10.93-－2.39, t=－3.40, P=0.005). In the injection group, VH recurrence occurred in 1 eye after IVR treatment. Vitrectomy (PPV) was performed in one eye. In the 8 eyes of the observation group, VH recurrence occurred in 2 eyes, subsequent PPV in 1 eye. The rate of VH recurrence and PPV was lower in the injection group, however, the difference was not statistically significant(P=0.576, 1.000). In terms of complications, minor subconjunctival hemorrhage occurred in 2 eyes and minor corneal epithelial injury occurred in 1 eye in the injection group, and all recovered spontaneously within a short time. In the injection group, 9 eyes had wide-angle fundus photography before and after IVR treatment. There was no significant change in the range of peripheral retinoschisis after treatment. No obvious proliferative vitreoretinopathy, infectious endophthalmitis, retinal detachment, macular hole, complicated cataract, secondary glaucoma or other serious complications were found in all the treated eyes, and there were no systemic complications. ConclusionIntravitreous anti-VEGF treatment may accelerate the absorption of vitreous hemorrhage in patients with XLRS. No impact is found regarding to the peripheral retinoschisis.
Objective To observe the etiological factors and variation of effects of nontraumatic severe vitreous hemorrhage. Methods A total of 1107 patients (1202 eyes) with nontraumatic severe vitreous hemorrhage who underwent vitrectomy from January 2005 to December 2011 were enrolled in this study. The patients were divided into A group (444 eyes of 415 patients were operated between January 2005 and December 2008) and group B (758 eyes of 692 patients between January 2009 and December 2011) according to admission date. The etiological factors and variations were recorded and retrospectively analyzed. Results Of all 444 eyes in group A, 156 eyes were due to retinal vein occlusion (RVO), 117 eyes associated with proliferative diabetic retinopathy (PDR), 61 eyes with retinal hole／retinal detachment (RH／RD), 42 eyes with Eales disease, 20 eyes with exudative agerelated macular degeneration (EAMD). These diagnoses accounting for 89.19% of the total eyes, were found to be the common causes in patients with severe vitreous hemorrhage, with RVO as the most common cause. Similarly in group B, severe vitreous hemorrhage was found in 347 eyes with proliferative diabetic retinopathy (PDR), 135 eyes with retinal hole／retinal detachment (RH／RD), 133 eyes with retinal vein occlusion (RVO), 25 eyes with Eales disease, 22 eyes with exudative age-related macular degeneration (EAMD), accounting for 87.87% of the total eyes. PDR was the most common cause instead of RVO to vitreous hemorrhage in this group. The number of vitreous hemorrhages increased year by year. Conclusions PDR, RH／RD, RVO, Eales disease and EAMD are the common causes of nontraumatic severe vitreous hemorrhage. There is a trend toward an increasing proportion of PDR among the causes of vitreous hemorrhage.
Objective To test the effects of large amount of blood in the vitreous on electrophysiological examination. Methods The reductions of transmission of flash light through a serial dilution and depth of whole blood were measured.An experimental model of vitreous hemorrhage in rabbits was established by injecting 0.5ml autologous uncoagulated whole blood into the vitreous cavities after compression with an expanding perfluoropropane gas bubble.Pars plana vitrectomy was performed to clear the blood clots 2 weeks after blood injection.Ganzfeld and bright-flash electroretinography were performed through six-week observation period. Results Blood reduced remarkably the transmission of reduced remarkably the transmission of bright-flash light.Massive vitreous hemorrhage had a dense filtering effect and extinguished the Ganzfeld but not the bright-flash electrotetinogram.About 3.5log units higher of the intensities of bright- flash light than that of conventional method could stimulate the responses of ERG-B waves in blood injected eyes.Slow recovery of Ganzfeld ERG-b waves after vitrectomy were noted within 2 weeks (Plt;0.05),AND ERG-b wave reached at 80-90% of normal level during the third week. Conclusion The ERG-b waves,which become undetectable because of absorption of the dense opacities of the absorption of the dense opacities of the vitreous in eyes with a large amount of vitreous hemorrhage,can be recorded in bright-flash light conditions with nearly nearly normal amplitudes.This result indicates that functions of retina were not severely damaged by the large amount of vitreous hemorrhage. The injection of large amount of blood into vitreous cavities may cause a transient reduction of the amplitudes of ERG-b waves. (Chin J Ocul Fundus Dis,1998,14:104-107)
Vitreous hemorrhage in children is caused by trauma or non-traumatic factors. Long-term vitreous hemorrhage not only affects children's vision, but also can lead secondary glaucoma, traumatic retinal detachment and other serious complications. Ocular trauma, some ocular and systemic diseases are the common etiology leading to vitreous hemorrhage in children. A small amount of vitreous hemorrhage can be treated by observation and conservative treatment. However, if the vitreous hemorrhage has no obvious absorption or serious complications appeared, it needs to be treated by surgery. The choice of treatment time and methods need to be further studied.
ObjectiveTo compare the effects of intravitreal tamponade of C3F8 with silicon oil on postoperative vitreous hemorrhage and visual prognosis after vitrectomy for proliferative diabetic retinopathy (PDR). MethodsThe clinical data of 121 patients (127 eyes) who underwent primary vitrectomy due to PDR were analyzed retrospectively. All the patients were divided into two groups according to different intravitreal tamponade, including C3F8 tamponade group (53 patients with 56 eyes) and silicone oil tamponade group (68 patients with 71 eyes). There was no difference of gender (χ2=0.956), age (t=1.122), duratiion of diabetes (t=0.627), fasting blood glucose (t=1.049), systolic pressure (t=1.056), diastolic pressure (t=0.517), history of hypertension (χ2=0.356), nephropathy (χ2=1.242), preoperative laser photocoagulation (χ2=1.225) and All the patients underwent three port pars plana vitrectomy. The mean follow-up was 2 years ranging from 6 months to 4 years. And then the incidence and onset time of postoperative vitreous hemorrhage and postoperative BCVA of the two groups were compared. ResultsPostoperative vitreous hemorrhage occurred in 14 of 56 eyes (25.00%) in C3F8 tamponade group. The average onset time of postoperative vitreous hemorrhage were (64.64±59.09) days ranging from 7-225 days and mostly were within 30-60 days (35.71%, 5/14). Postoperative vitreous hemorrhage also occurred in 7 of 71 eyes (9.89%) of silicone oil tamponade group after silicone oil removal with an average onset time of (25.29±20.46) days ranging from 3-65 days and were mostly within 15-30 days (42.86%, 3/7). There was a significant difference in the incidence of postoperative vitreous hemorrhage between the two groups (χ2=5.200, P<0.05). BCVA of the two groups was improved significantly after operation (Z=2.472, 3.114; P<0.05). Postoperative BCVA of silicone oil tamponade group was poorer than C3F8 tamponade group (Z=1.968, P<0.05). ConclusionBoth C3F8 and silicone oil tamponade can improve the visual acuity after vitrectomy for PDR. Compared with C3F8, silicone oil tamponade had lower incidence and late onset of postoperative vitreous hemorrhage after vitrectomy for PDR.
Objective To observe the efficacy of vitrectomy for vitreous hemorrhage in patients with polypoidal choroidal vasculopathy (PCV). Methods Fourteen patients (14 eyes) of PCV with vitreous hemorrhage diagnosed by routine ophthalmologic examination, A and/or B mode ultrasound, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were enrolled in this study. The patients included eight males (eight eyes) and six females (six eyes), with the mean age of (58.7plusmn;6.0) years. All patients received vitrectomy with silicone oil and C3F8 gas tamponade. There were eight eyes received photodynamic therapy (PDT) after surgery. The retinal reattachment, visual acuity, pathological lesion degree and complications were comparatively analyzed. Results Among 14 eyes, six eyes (42.9%) recovered, seven eyes (50.0%) improved, and one eye (7.1%) aggravated. Ten eyes achieved retinal reattachment after surgery, while four eyes developed retinal detachment after the first surgery. The retina remained attached in these three eyes after silicon oil tamponade, C3F8 gas tamponade and scleral buckling, respectively; but one eye maintained silicon oil without special treatment. Thirteen eyes (92.9%) achieved retinal reattachment finally. Five eyes of them occurred hyphema one to seven days after surgery, but hyphema was absorbed and intraocular pressure was stable after douche of anterior chamber and pharmacotherapy. The vision improved with more than two lines in one eyes, improved with one to two lines in one eye, unchanged in 10 eyes, and decreased in two eyes. Of eight eyes who underwent PDT, abnormal vessels regressed in five eyes, abnormal vessels remained in three eyes. Conclusions Vitrectomy can remove cloudy refracting media for PCV with vitreous hemorrhage. The combined treatment of vitrectomy and PDT can improve or stabilize visual function,is an effective therapy for the PCV with vitreous hemorrhage.
Objective To investigate the relationship of macular microstructure and visual prognosis of micro-invasive vitrectomy for diabetic vitreous hemorrhage. Methods Fifty-three patients (53 eyes) with diabetic vitreous hemorrhage who underwent microinvasive vitrectomy were enrolled in this retrospective study. The preoperative and postoperative best-corrected visual acuities (BCVA) were recorded. The central foveal thicknesses (CFT) were measured after surgery by spectral domainoptical coherence tomography (SD-OCT). The median follow-up time was (12.81plusmn;8.22) months, ranging from six to 36 months. According to the results of SD-OCT at last follow-up time, macular edema (ME), epiretinal membrane (ERM), interrupted inside and outside section (IS/OS) and interrupted external limiting membrane (ELM) were macular abnormalities were observed. The preoperative and postoperative BCVA of different macular abnormalities were comparatively analyzed. The correlation between BCVA and macular microstructure were analyzed. Results The CFT was ranged from 103.00 mu;m to 498.00 mu;m,with the mean of（251.12plusmn;90.23） mu;m. Macular abnormalities were observed in 37 eyes (69.8%), and normal macula in 16 eyes (30.2%). Among 37 eyes with macular abnormalities, there were 20 eyes (37.7%) with ME, 12 eyes (22.6%) with ERM, 33 eyes (62.3%) with interrupted IS/OS, and 20 eyes (37.7%) with interrupted ELM. The BCVA of ME eyes decreased significantly than that in nonME eyes （t=-2.09，P＜0.05). The difference of BCVA in ERM and nonERM eyes was not statistically significant (t=-1.10,P＞0.05). The BCVA of interrupted IS/OS eyes decreased significantly more than that in continuous IS/OS eyes （t=-4.33,P＜0.05). The BCVA of interrupted ELM eyes decreased significantly more than that in continuous ELM eyes (t=-2.58, P＜0.05). The postoperative BCVA correlated positively with integrity of the IS/OS junction, CFT, and whether ME or not (r=7.65, 8.21, 4.99; P＜0.05), but insignificantly associated with integrity of the ELM and whether ERM or not (r=0.01, 0.82; P＞0.05). Conclusion The final visual acuity of patients with diabetic vitreous hemorrhage after micro-invasive vitrectomy is related to the CFT，the status of IS/OS junction, whether ME or not, but not related to integrity of the ELM or whether ERM or not.
Objective To investigate the incidence, risk factors and relationship with intraocular hemorrhage of Tersonprime;s syndrome among patients with spontaneous subarachnoid hemorrhage (SSAH) after emergency admission. Methods Seventy-four consecutive patients with SSAH from June 2010 to September 2011 were prospectively examined. A direct ophthalmoscope examination was performed in all participants within three hours after emergency admission. If circumstances permit, fundus photos were taken. When initial fundus examination was conducted, the Hunt-Hess grade was classified by the brain surgeon. The fundus examination was taken on the 1st, 3rd, and 7th day, 2 weeks, 1 month, and 3 months after emergency admission. The details were recorded, including sex, age, bleeding patterns, Hunt-Hess grade and death. The incidence of Tersonprime;s syndrome was analyzed and correlated with sex, age and Hunt-Hess grade. The relationship between intraocular hemorrhage and Hunt-Hess grade and mortality was analyzed. Results Among the 74 patients, 19 were suffering from Tersonprime;s syndrome, 31 eyes involved. The incidence of Tersonprime;s syndrome was 25.7%. Statistical analysis demonstrated that the sex of the patient was randomly distributed (chi;2=0.071,P=0.790), and the age components were also randomly distributed (Fisherprime;s exact test.P=0.203). The Hunt-Hess grade components were nonrandomly distributed (Fisherprime;s exact test，P=0.000). Among the patients with preretinal hemorrhage and vitreous hemorrhage, Hunt-Hess grade Ⅴ was in 76.9% patients; among inte-retinal hemorrhage, Hunt-Hess grade was in 16.7% of patients. The distribution was non-random (Fisherprime;s exact test.P=0.041). All intraocular hemorrhages were found at the time of first fundus examination. The mortality from Tersonprime;s syndrome was 68.4% (13/19) according to the follow-up investigation. The mortality in patients with vitreous hemorrhage and preretinal hemorrhage was statistically different (Fisherprime;s exact test.P=0.046) from patients with inter-retinal hemorrhage. Among the six recovered Tersonprime;s syndrome patients, two of them were recovered from vitrectomy, and the other four were recovered from selfabsorption. Conclusions A higher frequency (25.7%) of Tersonprime;s syndrome was observed in patients with SSAH. The incidence is highly related to the general condition of the patient but not to the sex or age. Intraocular hemorrhage is more likely to happen in the early time of SSAH. People with more severe intraocular hemorrhage may have worse general condition or higher mortality.