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Indian Journal of Ophthalmology Jan 2023Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and... (Review)
Review
Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.
Topics: Humans; Vitreous Hemorrhage; Vitrectomy; Vitreous Detachment; Vitreoretinopathy, Proliferative; Diabetic Retinopathy; Glaucoma; Retinal Perforations
PubMed: 36588205
DOI: 10.4103/ijo.IJO_928_22 -
JAMA Dec 2020Vitreous hemorrhage from proliferative diabetic retinopathy can cause loss of vision. The best management approach is unknown. (Comparative Study)
Comparative Study Randomized Controlled Trial
Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy: A Randomized Clinical Trial.
IMPORTANCE
Vitreous hemorrhage from proliferative diabetic retinopathy can cause loss of vision. The best management approach is unknown.
OBJECTIVE
To compare initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation for vitreous hemorrhage from proliferative diabetic retinopathy.
DESIGN, SETTING, AND PARTICIPANTS
Randomized clinical trial at 39 DRCR Retina Network sites in the US and Canada including 205 adults with vison loss due to vitreous hemorrhage from proliferative diabetic retinopathy who were enrolled from November 2016 to December 2017. The final follow-up visit was completed in January 2020.
INTERVENTIONS
Random assignment of eyes (1 per participant) to aflibercept (100 participants) or vitrectomy with panretinal photocoagulation (105 participants). Participants whose eyes were assigned to aflibercept initially received 4 monthly injections. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol criteria.
MAIN OUTCOMES AND MEASURES
The primary outcome was mean visual acuity letter score (range, 0-100; higher scores indicate better vision) over 24 weeks (area under the curve); the study was powered to detect a difference of 8 letters. Secondary outcomes included mean visual acuity at 4 weeks and 2 years.
RESULTS
Among 205 participants (205 eyes) who were randomized (mean [SD] age, 57 [11] years; 115 [56%] men; mean visual acuity letter score, 34.5 [Snellen equivalent, 20/200]), 95% (195 of 205) completed the 24-week visit and 90% (177 of 196, excluding 9 deaths) completed the 2-year visit. The mean visual acuity letter score over 24 weeks was 59.3 (Snellen equivalent, 20/63) (95% CI, 54.9 to 63.7) in the aflibercept group vs 63.0 (Snellen equivalent, 20/63) (95% CI, 58.6 to 67.3) in the vitrectomy group (adjusted difference, -5.0 [95% CI, -10.2 to 0.3], P = .06). Among 23 secondary outcomes, 15 showed no significant difference. The mean visual acuity letter score was 52.6 (Snellen equivalent, 20/100) in the aflibercept group vs 62.3 (Snellen equivalent, 20/63) in the vitrectomy group at 4 weeks (adjusted difference, -11.2 [95% CI, -18.5 to -3.9], P = .003) and 73.7 (Snellen equivalent, 20/40) vs 71.0 (Snellen equivalent, 20/40) at 2 years (adjusted difference, 2.7 [95% CI, -3.1 to 8.4], P = .36). Over 2 years, 33 eyes (33%) assigned to aflibercept received vitrectomy and 34 eyes (32%) assigned to vitrectomy received subsequent aflibercept.
CONCLUSIONS AND RELEVANCE
Among participants whose eyes had vitreous hemorrhage from proliferative diabetic retinopathy, there was no statistically significant difference in the primary outcome of mean visual acuity letter score over 24 weeks following initial treatment with intravitreous aflibercept vs vitrectomy with panretinal photocoagulation. However, the study may have been underpowered, considering the range of the 95% CI, to detect a clinically important benefit in favor of initial vitrectomy with panretinal photocoagulation.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02858076.
Topics: Aged; Angiogenesis Inhibitors; Cataract Extraction; Confidence Intervals; Diabetic Retinopathy; Female; Humans; Intravitreal Injections; Light Coagulation; Male; Middle Aged; Postoperative Complications; Receptors, Vascular Endothelial Growth Factor; Recombinant Fusion Proteins; Retina; Treatment Outcome; Vascular Endothelial Growth Factor A; Visual Acuity; Vitrectomy; Vitreous Hemorrhage
PubMed: 33320223
DOI: 10.1001/jama.2020.23027 -
Primary Care Sep 2015Flashes and floaters are common ocular complaints. Flashes refer to aberrations of light that are seen in a patient's field of gaze. The flashes can be of varying sizes,... (Review)
Review
Flashes and floaters are common ocular complaints. Flashes refer to aberrations of light that are seen in a patient's field of gaze. The flashes can be of varying sizes, colors, frequency, and durations, depending on the cause. Floaters are another common visual phenomenon caused by particles or debris in the vitreous gel of the eye that cause shadows and thus visual changes, especially against bright backgrounds and in brightly lit environments. Flashes and floaters can occur individually or together. This article discusses common causes of flashes and floaters to help with the triaging and management of these patients.
Topics: Comorbidity; Diabetic Retinopathy; Diagnosis, Differential; Eye Diseases; Humans; Migraine Disorders; Primary Health Care; Referral and Consultation; Retinal Perforations; Risk Factors; Self Care; Vitreous Detachment; Vitreous Hemorrhage
PubMed: 26319347
DOI: 10.1016/j.pop.2015.05.011 -
Primary Care Sep 2015Acute vision loss can be transient (lasting <24 hours) or persistent (lasting >24 hours). When patients present with acute vision loss, it is important to ascertain... (Review)
Review
Acute vision loss can be transient (lasting <24 hours) or persistent (lasting >24 hours). When patients present with acute vision loss, it is important to ascertain the duration of vision loss and whether it is a unilateral process affecting one eye or a bilateral process affecting both eyes. This article focuses on causes of acute vision loss in the nontraumatic setting and provides management pearls to help health care providers better triage these patients.
Topics: Acute Disease; Amaurosis Fugax; Blindness; Glaucoma, Angle-Closure; Humans; Migraine Disorders; Optic Nerve Diseases; Optic Neuritis; Papilledema; Primary Health Care; Referral and Consultation; Retinal Artery Occlusion; Retinal Detachment; Retinal Vein Occlusion; Stroke; Time Factors; Vertebrobasilar Insufficiency; Vitreous Hemorrhage
PubMed: 26319342
DOI: 10.1016/j.pop.2015.05.010 -
Journal Francais D'ophtalmologie Feb 2016Spontaneous vitreous hemorrhage is a serious disease whose incidence is 7 per 100,000 people per year. Posterior vitreous detachment with or without retinal tear,... (Review)
Review
Spontaneous vitreous hemorrhage is a serious disease whose incidence is 7 per 100,000 people per year. Posterior vitreous detachment with or without retinal tear, diabetic retinopathy, vascular proliferation after retinal vein occlusion, age-related macular degeneration and Terson's syndrome are the most common causes. Repeated ultrasonography may ignore a retinal tear or detachment and delay vitrectomy that is the only treatment for serious forms. The occurrence of retinal tear or detachment is a surgical emergency as well as rubeosis or diabetic tractional retinal detachment involving the macula. Intravitreal injection of antiangiogenic agents are helpful in clearing the vitreous cavity, facilitating laser photocoagulation and reducing the risks of bleeding during preretinal neovascular membranes dissection.
Topics: Anticoagulants; Diabetic Retinopathy; Humans; Hypertension; Macular Degeneration; Retinal Detachment; Retinal Perforations; Vitrectomy; Vitreous Detachment; Vitreous Hemorrhage
PubMed: 26826742
DOI: 10.1016/j.jfo.2015.11.001 -
Indian Journal of Ophthalmology Jun 2019Vitreous hemorrhage is one of the most common causes of sudden, painless loss of vision in adults. This is probably one of the reasons why it has been extensively... (Review)
Review
Vitreous hemorrhage is one of the most common causes of sudden, painless loss of vision in adults. This is probably one of the reasons why it has been extensively studied and reported in literature. However, the same cannot be said when it comes to vitreous hemorrhage in the pediatric age group. The causes of vitreous hemorrhage in children tend to differ from those of adults. Not much data exist regarding their presentation and management. In addition to trauma, certain spontaneous causes such as pediatric tumors and congenital conditions assume importance while considering the differential diagnosis of vitreous hemorrhage in the pediatric age group. However, it is natural that the treating ophthalmologist is faced with challenges when a child presents with vitreous hemorrhage. In this narrative review, we have attempted to analyze the retrospective observational studies regarding pediatric vitreous hemorrhage reported in English literature till date. The article sheds some light on the prevailing epidemiology, management strategies employed and the visual outcome among different regions of the world.
Topics: Child; Disease Management; Global Health; Humans; Morbidity; Visual Acuity; Vitreous Body; Vitreous Hemorrhage
PubMed: 31124481
DOI: 10.4103/ijo.IJO_688_18 -
Indian Journal of Ophthalmology Jun 2020The present review describes the posterior segment complications following surgical management of glaucoma. Although the majority of glaucoma cases are managed... (Review)
Review
The present review describes the posterior segment complications following surgical management of glaucoma. Although the majority of glaucoma cases are managed medically, still a large number of patients may require surgery. Moreover, with the advent of newer surgical techniques and adjuncts, encountering retinal complications post-surgery is not uncommon. The incidence, signs, management, and prognosis of common complications such as anesthesia-related retinal toxicity, vitreous loss, suprachoroidal hemorrhage, serous choroidal detachment, hypotonic maculopathy, vitreous hemorrhage, retinal detachment and endophthalmitis will be discussed in detail. Awareness of these complications is necessary as their proper and timely management can save vision in an already compromised eye.
Topics: Choroid Hemorrhage; Glaucoma; Humans; Ophthalmologic Surgical Procedures; Postoperative Complications; Retinal Detachment; Retrospective Studies; Vitrectomy; Vitreous Hemorrhage
PubMed: 32461411
DOI: 10.4103/ijo.IJO_1040_19 -
Retinal Cases & Brief ReportsTo describe the treatment and natural history of a patient with complicated congenital retinoschisis.
PURPOSE
To describe the treatment and natural history of a patient with complicated congenital retinoschisis.
METHODS
A retrospective case report. A 10-month-old boy with congenital retinoschisis presented with tractional retinal detachments and foveal schisis in both eyes.
RESULTS
On presentation, vision was decreased in both eyes with presumed amblyopia of the left eye. Funduscopic examination revealed bilateral foveal schisis and tractional retinal detachment involving the macula. Follow-up examination revealed superior retinal dragging and peripheral ischemia on fluorescein angiogram in both eyes. Nine months after presentation, combined rhegmatogenous and tractional retinal detachment developed in the right eye and was treated by scleral buckle. After vitrectomy for nonclearing vitreous hemorrhage in the left eye, a combined rhegmatogenous and tractional retinal detachment developed. Vitrectomy and lensectomy with silicone oil was performed. At 6 years of follow-up, both retinas were attached and foveal schisis had resolved.
CONCLUSION
Sight threatening complications of congenital retinoschisis include retinal detachment and vitreous hemorrhage. Vitrectomy and/or scleral buckling may prevent progression of vision loss and promote resolution of schisis.
Topics: Fovea Centralis; Humans; Infant; Male; Retinal Detachment; Retinoschisis; Retrospective Studies; Scleral Buckling; Treatment Outcome; Vitrectomy; Vitreous Hemorrhage
PubMed: 27680778
DOI: 10.1097/ICB.0000000000000444 -
Die Ophthalmologie Oct 2023
Topics: Humans; Vitreous Body; Vitrectomy; Macular Degeneration; Vitreous Hemorrhage
PubMed: 37855978
DOI: 10.1007/s00347-023-01932-3 -
Current Diabetes Reports Oct 2016New modalities for the treatment of diabetic eye complications have emerged in the past decade. Nevertheless, many severe diabetic retinopathy complications can only be... (Review)
Review
New modalities for the treatment of diabetic eye complications have emerged in the past decade. Nevertheless, many severe diabetic retinopathy complications can only be treated with vitreoretinal surgery. Technological advances in pars plana vitrectomy have expanded the gamut of pathologies that can be successfully treated with surgery. The most common pathologies managed surgically include vitreous opacities and traction retinal detachment. The indications, surgical objectives, adjunctive pharmacotherapy, microincisional surgical techniques, and outcomes of diabetic vitrectomy for proliferative diabetic retinopathy and diabetic tractional retinal detachment will be discussed. With the availability of new microincisional vitrectomy technology, wide angle microscope viewing systems, and pharmacologic agents, vitrectomy can improve visual acuity and achieve long-term anatomic stability in eyes with severe complications from proliferative diabetic retinopathy.
Topics: Diabetic Retinopathy; Humans; Retinal Detachment; Visual Acuity; Vitrectomy; Vitreous Hemorrhage
PubMed: 27612846
DOI: 10.1007/s11892-016-0787-6