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European Journal of Ophthalmology Sep 2023
Topics: Humans; Male; COVID-19; COVID-19 Vaccines; Priapism; Vaccination; Vitreous Hemorrhage
PubMed: 37291877
DOI: 10.1177/11206721231172290 -
Current Opinion in Ophthalmology May 2023The prevalence of diabetic retinopathy continues to rise. This review highlights advances in imaging, medical, and surgical management of proliferative diabetic... (Review)
Review
PURPOSE OF REVIEW
The prevalence of diabetic retinopathy continues to rise. This review highlights advances in imaging, medical, and surgical management of proliferative diabetic retinopathy (PDR) in recent years.
RECENT FINDINGS
Ultra-widefield fluorescein angiography has been shown to better characterize which patients have predominantly peripheral lesions and who may advance to more advanced forms of diabetic retinopathy. This was well demonstrated in DRCR Retina Network's Protocol AA. Protocol S demonstrated that antivascular endothelial growth factor (VEGF) treatment alone can be useful in the management of select PDR patients - particularly those without high-risk features. However, a growing body of literature highlights how lapse in care is a significant concern in PDR patients, and tailoring one's approach to treatment based on patient needs is recommended. In patients with high-risk features or where there is concern for lost-to-follow-up, incorporation of panretinal photocoagulation in the treatment paradigm is recommended. Protocol AB highlighted how patients with more advanced disease may benefit from earlier surgical intervention for earlier visual recovery but that continued anti-VEGF treatment may result in similar visual outcomes over a longer period. Finally, earlier surgical intervention for PDR without vitreous hemorrhage (VH) or retinal detachment is being considered a potential option to minimize treatment burden.
SUMMARY
Recent advances in imaging, as well as medical and surgical treatment options for PDR, have provided a deeper understanding of PDR management, which can be optimized for the individual patient.
Topics: Humans; Diabetic Retinopathy; Retina; Vitreous Body; Laser Coagulation; Vitreous Hemorrhage; Diabetes Mellitus
PubMed: 36866849
DOI: 10.1097/ICU.0000000000000946 -
Retinal Cases & Brief Reports Nov 2022To discuss the mechanism of injury and characterize the clinical features of ocular trauma associated with elastic cord exercise equipment band injuries in a consecutive...
PURPOSE
To discuss the mechanism of injury and characterize the clinical features of ocular trauma associated with elastic cord exercise equipment band injuries in a consecutive series of patients seen at a single vitreoretinal surgery practice.
METHODS
We performed a retrospective review of all patients who were treated for blunt trauma from 2013 to 2020 at a single vitreoretinal practice.
RESULTS
Thirteen eyes from 11 patients met the inclusion criteria of possessing ocular trauma secondary to recoil from exercise bands. Presenting visual acuity ranged from 20/16 to HM (median: 20/32). The most frequently observed anterior segment pathologies were traumatic iritis (54%) and angle recession (31%). The most common posterior segment findings were vitreous hemorrhage (54%) and peripheral commotio retinae (54%). Three eyes (23%) required surgical intervention. Follow-up intervals ranged from 0 to 10 months (median: 1.75 months). Visual acuity at last examination ranged from 20/13 to 20/400 (median: 20/40).
CONCLUSION
A wide spectrum of serious ocular injuries requiring medical and surgical intervention can result from this form of blunt ocular trauma. The frequency of this event would be decreased by the use of sports goggles and careful inspection of equipment for wear and over use.
Topics: Humans; Eye Injuries; Visual Acuity; Vitreous Hemorrhage; Wounds, Nonpenetrating; Retrospective Studies
PubMed: 33165305
DOI: 10.1097/ICB.0000000000001078 -
Indian Journal of Ophthalmology Mar 2023To study the presentation and outcomes of infantile Terson syndrome (TS).
PURPOSE
To study the presentation and outcomes of infantile Terson syndrome (TS).
METHODS
This was a retrospective analysis of 18 eyes of nine infants diagnosed to have TS-related intraocular hemorrhage (IOH).
RESULTS
Nine infants (seven males) were diagnosed to have IOH secondary to TS, of which eight infants had imaging features suggestive of intracranial bleed meeting our definite criteria. Median age at presentation was 5 months. In 11 eyes of six infants with suspected birth trauma, the median age of presentation was 4.5 months (range 1-5 months) of which one baby had a history of suction cup-aided delivery and four babies had a history of seizures. Vitreous hemorrhage (VH) was noted in 15 eyes (extensive in 11 eyes). Ten of these eyes showed membranous vitreous echoes, or triangular hyperechoic space with apex at the optic nerve head (ONH) posteriorly and base at the posterior lens capsule anteriorly, with or without dot echoes in the rest of the vitreous cavity, with a configuration of "tornado-like hemorrhage" suggestive of Cloquet's canal hemorrhage (CCH). Eight eyes underwent lens-sparing vitrectomy (LSV) and one eye underwent lensectomy with vitrectomy (LV). On follow-up, disc pallor and retinal atrophy were noted in 11 and 10 eyes, respectively. The mean follow-up was 62 months (1.5 month-16 years). Visual acuity/behavior improved in all cases at the final follow-up. Developmental delay was noted in four children.
CONCLUSION
Unexplained and altered vitreous hemorrhage with typical ultrasonography (USG) features should raise the suspicion of CCH in TS. Despite early intervention to clear visual axis, anatomical and visual behavior may remain subnormal.
Topics: Infant; Child; Male; Humans; Vitreous Hemorrhage; Retrospective Studies; Optic Disk; Lens, Crystalline; Vitrectomy
PubMed: 36872705
DOI: 10.4103/ijo.IJO_1991_22 -
Retinal Cases & Brief ReportsTo present a unique case of polypoidal choroidal vasculopathy presenting as a blind, painful eye with a suspected intraocular mass, and to correlate clinical findings... (Review)
Review
PURPOSE
To present a unique case of polypoidal choroidal vasculopathy presenting as a blind, painful eye with a suspected intraocular mass, and to correlate clinical findings with histopathologic studies.
METHODS
Clinical case report and literature review.
RESULTS
A 58-year-old Vietnamese man presented with a blind, painful eye with concern for an intraocular mass. B-scan ultrasonography showed massive intraocular hemorrhage and could not rule out a tumor. The patient underwent enucleation and the histopathologic findings were consistent with polypoidal choroidal vasculopathy.
CONCLUSION
Polypoidal choroidal vasculopathy can present with dense vitreous hemorrhage and may masquerade as an intraocular mass. It can progress rapidly and lead to profound, irreversible vision loss. A diagnosis of polypoidal choroidal vasculopathy should be considered in patients of African or East Asian origin presenting with vitreous hemorrhage.
Topics: Choroid Diseases; Eye Enucleation; Humans; Male; Middle Aged; Retinal Detachment; Vitreous Hemorrhage
PubMed: 27930435
DOI: 10.1097/ICB.0000000000000464 -
Disease-a-month : DM Mar 2017
Review
Topics: Humans; Referral and Consultation; Retinal Detachment; Retinal Perforations; Vision Disorders; Vitreous Body; Vitreous Detachment; Vitreous Hemorrhage
PubMed: 28010949
DOI: 10.1016/j.disamonth.2016.10.005 -
Retina (Philadelphia, Pa.) May 2023Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare degenerative disease that affects the peripheral retina. Reports of PEHCR in Asian patients are...
PURPOSE
Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare degenerative disease that affects the peripheral retina. Reports of PEHCR in Asian patients are rare. Thus, the aim of this study was to investigate the clinical characteristics and outcomes of PEHCR in Asian patients.
METHODS
A retrospective chart review of 33 eyes of 29 Asian patients with PEHCR.
RESULTS
The mean age of the patients was 70 years, and 75.9% of them were women. Vitreous hemorrhage occurred in 51.5% of eyes during a mean follow-up of 43.1 months. The occurrence of vitreous hemorrhage was associated with a thicker baseline subfoveal choroid ( P = 0.001) and the male sex ( P = 0.005). Final visual acuity was less than 20/200 in 29.2% of eyes. The predictive factors for a final visual acuity worse than 20/200 included poor initial visual acuity ( P = 0.002), initial lesion involvement of more than 180° of the peripheral retina ( P = 0.03), an extension of subretinal hemorrhage to the macula ( P = 0.040), and absence of complete tumor regression ( P = 0.02).
CONCLUSION
Asian PEHCR patients seem to be more frequently associated with vitreous hemorrhages, especially in male patients with thicker choroids. Although PEHCR was largely self-limiting, approximately one-third of the eyes ended up with a visual acuity of less than 20/200 with extensive lesion involvement.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Asian; Chorioretinitis; Choroid Diseases; Retina; Retinal Diseases; Retinal Hemorrhage; Retrospective Studies; Vitreous Hemorrhage; Treatment Outcome
PubMed: 36729533
DOI: 10.1097/IAE.0000000000003702 -
Clinical Neurology and Neurosurgery Nov 2021Terson's Syndrome describes intraocular hemorrhage secondary to an acutely raised intracranial pressure (ICP). Although Terson's Syndrome is common amongst patients with... (Review)
Review
Terson's Syndrome describes intraocular hemorrhage secondary to an acutely raised intracranial pressure (ICP). Although Terson's Syndrome is common amongst patients with subarachnoid hemorrhage (SAH), it is underdiagnosed and often overlooked. This review discusses the current understanding of the etiopathogenesis, clinical features, and management of Terson's Syndrome and highlights the visual and prognostic implications to stress the importance of timely diagnosis and management. The origin of intraocular hemorrhage in Terson's Syndrome has been debated. A recognized theory suggests that an acutely raised ICP induces effusion of cerebrospinal fluid into the optic nerve sheath which dilates the retrobulbar aspect of the sheath in the orbit. Dilatation mechanically compresses the central retinal vein and retinochoroidal veins resulting in venous hypertension and rupture of thin retinal vessels. A commonly reported clinical feature is decreased visual acuity and blurred vision. These may be accompanied by symptoms of increased ICP including loss of consciousness and headache. Diagnosis is established using evidence from the clinical presentation, ophthalmoscopy, and, when required, imaging including B-mode ultrasound, CT, MRI, and fluorescein angiography. Terson's Syndrome is managed conservatively by observation for mild cases and with vitrectomy for bilateral cases and for patients whose hemorrhage has not spontaneously resolved after an observational period. Terson's Syndrome can be used as a prognostic indicator of morbidity and mortality in underlying pathology like SAH. Fundoscopy of patients with SAH, acutely raised ICP or visual disturbance with unknown etiology can help establish a timely Terson's Syndrome diagnosis. This may avoid the risk of permanent visual impairment.
Topics: Conservative Treatment; Disease Management; Humans; Intracranial Pressure; Neurosurgical Procedures; Ophthalmoscopy; Vision Disorders; Visual Acuity; Vitreous Hemorrhage
PubMed: 34775364
DOI: 10.1016/j.clineuro.2021.107008 -
[Zhonghua Yan Ke Za Zhi] Chinese... Jun 2022To observe the clinical features, intervention and outcomes of anatomic and visual functions of Terson syndrome in infants, and to explore the appropriate timing for...
To observe the clinical features, intervention and outcomes of anatomic and visual functions of Terson syndrome in infants, and to explore the appropriate timing for surgery. This retrospective study included 23 eyes of 14 infants diagnosed with vitreous hemorrhage related to Terson syndrome between May 2008 and March 2021 in Department of Ophthalmology, Peking University People's Hospital. There were 7 males (11 eyes) and 7 females (12 eyes). The age at the initial visit was (4.59±3.96) months. No obvious abnormality was observed in the anterior segment of both eyes of each patient. Data were collected, including demographics, causes of intracranial hemorrhage, characteristics of intraocular hemorrhage, intervention, outcomes of anatomic and visual functions. The causes were craniocerebral trauma in 3 patients, idiopathic cysts in 8 patients, ependymal cyst rupture in 1 patient and respiratory distress in 2 patients. The chief complaint was behavior change in 9 patients, and hemorrhage was found in 5 patients on fundus examination. The rate of complications related to intraocular bleeding was 12/16 when the duration was less than 3 months and 6/7 when the duration was more than 3 months. Twenty eyes (86.96%) were treated by vitrectomy. The follow-up ranged from 6 to 160 months. Three eyes were atrophied, anatomical success was recorded in 18 eyes, and retinal detachment developed in 2 eyes. The visual acuity was improved in 12 eyes (60%), unchanged in 5 eyes (25%), and deteriorated in 3 eyes (15%), except 3 eyes that did not comply with visual acuity examination. Ten eyes showed an obvious myopic shift. The vitreous hemorrhage related to Terson syndrome can occlude the macula and cause severe structural and functional impairments in infants. Vitrectomy is an effective intervention technique, which can quickly remove blood accumulation and restore the anatomical structure, providing better conditions for the visual development of infants.
Topics: Female; Humans; Infant; Male; Retinal Detachment; Retrospective Studies; Visual Acuity; Vitrectomy; Vitreous Hemorrhage
PubMed: 35692023
DOI: 10.3760/cma.j.cn112142-20211126-00564 -
Ophthalmology. Retina Mar 2023
Topics: Humans; Vitreous Hemorrhage; Leber Congenital Amaurosis
PubMed: 36646578
DOI: 10.1016/j.oret.2022.12.005