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Ophthalmology. Retina Jan 2023To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment.
PURPOSE
To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment.
DESIGN
International, multicenter, noncomparative retrospective case series.
PARTICIPANTS
We analyzed 264 eyes of 238 patients from 13 centers worldwide who developed vitreoretinal complications (retinal detachment [RD], vitreous hemorrhage [VH], or retinal break) ≥ 2 years after resolution of acute ROP.
METHODS
Each participant was assigned to 1 of 3 groups (the RD, VH, and retinal break groups) according to their primary diagnosis. The average age at presentation, visual acuities, refractive error, axial length, gestational age, birth weight, acute ROP classification, prior treatments for acute ROP, postoperative visual acuity (VA), and concomitant eye conditions in the 3 groups were documented and compared.
MAIN OUTCOME MEASURES
Clinical features and visual outcomes of late vitreoretinal complications in patients with regressed ROP.
RESULTS
A total of 264 eyes of 238 patients were included. The prior acute ROP status was comparable among the 3 groups, except that the VH group had a higher proportion of patients with type 1 ROP (P = 0.03) and prior treatment (P < 0.001) than the other groups. The average age at presentation was earlier in the RD (20.3 ± 15.5 years) and VH (21.4 ± 18.9 years) groups than in the retinal break group (31.9 ± 18.2 years; P < 0.001). The retinal break group had the best presenting best-corrected VA, followed by the RD and VH groups (P < 0.001). Surgical intervention improved VA in both the RD and VH groups (both P < 0.05). The overall trend of VA was the most favorable in the retinal break group, followed by that in the VH and RD groups. Cicatricial changes in the fellow retina were observed in > 90% of patients with unilateral involvement.
CONCLUSIONS
Infants with acute ROP remain at a high risk of vision-threatening complications throughout childhood and adulthood. Continual follow-up of patients with ROP is important. When severe complications, such as RD or VH, are detected, timely surgical intervention is necessary to ensure favorable visual outcomes in these patients.
Topics: Infant; Infant, Newborn; Humans; Adult; Child; Retinal Detachment; Retinal Perforations; Vitreous Hemorrhage; Retinopathy of Prematurity; Retrospective Studies; Treatment Outcome; Follow-Up Studies; Vitrectomy; Retina
PubMed: 35843486
DOI: 10.1016/j.oret.2022.07.005 -
Journal of the American Pharmacists... 2023The purpose of this case report is to describe a case of vitreous hemorrhage in a patient with a history of diabetic retinopathy and receiving dulaglutide for the...
BACKGROUND
The purpose of this case report is to describe a case of vitreous hemorrhage in a patient with a history of diabetic retinopathy and receiving dulaglutide for the management of type 2 diabetes mellitus (T2DM).
CASE SUMMARY
A 64-year-old African American male with a past medical history of T2DM and severe diabetic retinopathy for 4 years was restarted on dulaglutide 1.5 mg weekly after being off therapy for 3 months. Baseline laboratory test results included hemoglobin A1c (HbA1c) of 8.8% and random blood glucose (BG) of 280 mg/dL. In addition, the patient had an average fasting BG of 150 mg/dL. In absence of intolerance, the dulaglutide dose was gradually maximized to 4.5 mg weekly and HbA1c decreased to 7.3% and random BG to 121 mg/dL at week 12 since reinitiation. At week 17 of therapy, the patient presented to the emergency department with a 1-day history of vision loss in the left eye and was diagnosed as having vitreous hemorrhage. The etiology for vitreous hemorrhage is unclear and may be a spontaneous episode. In discussion with the patient and the ophthalmologist, dulaglutide was restarted at 1.5 mg once weekly. After 4 weeks of reinitiation, the patient denied any recurrent symptoms of vitreous hemorrhage or worsening diabetic retinopathy. The most recent ophthalmology evaluation indicated no change in diabetic retinopathy.
PRACTICE IMPLICATIONS
This case report adds to the limited body of evidence available for the incidence of vitreous hemorrhage in the setting of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) therapy and pre-existing diabetic retinopathy. The case report illustrates that a history of diabetic retinopathy should not automatically preclude the use of GLP-1 RAs.
Topics: Male; Humans; Middle Aged; Diabetes Mellitus, Type 2; Hypoglycemic Agents; Glycated Hemoglobin; Glucagon-Like Peptide-1 Receptor; Blood Glucose; Vitreous Hemorrhage; Diabetic Retinopathy; Glucagon-Like Peptides; Immunoglobulin Fc Fragments; Glucagon-Like Peptide 1; Recombinant Fusion Proteins
PubMed: 36966088
DOI: 10.1016/j.japh.2023.02.018 -
Nigerian Journal of Clinical Practice Sep 2021To investigate the prevalence and presentation of polypoidal choroidal vasculopathy (PCV) in Nigerians.
OBJECTIVE
To investigate the prevalence and presentation of polypoidal choroidal vasculopathy (PCV) in Nigerians.
METHODS
A cross-sectional, multicenter, hospital-based, descriptive study. Data were collected prospectively between January and December 2018, from consecutive patients diagnosed to have a retina disease at the general outpatient and retinal clinics of four eye departments in Nigeria. All participants had visual acuity, refraction, intraocular pressure, anterior segment examination, and dilated fundus examination. Some patients had fundus fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA). Systemic comorbidity was determined by medical history and systemic evaluation. Diagnosis of PCV was based on clinical findings, and in some patients using OCT.
RESULTS
A total of 8,614 patients were seen and 15 patients (18 eyes) were diagnosed to have PCV giving a yearly hospital-based prevalence of 0.17%. The mean age at presentation was 63.27 ± 11.5 years (range 44-84 years). There were nine females (60%). The male: female ratio was 1.5:1. Twelve (66.7%) of the 18 eyes were blind, 16.7% had severe visual impairment while 11.1% had mild visual impairment. Seven eyes (38.9%) had vitreous hemorrhage. Of the 12 blind eyes, 50% had vitreous hemorrhage (P = 0.463). Nine patients (60%) had systemic hypertensive as comorbidity (P = 0.016).
CONCLUSION
PCV is a cause of vision loss among Nigerians. Majority of the eyes were blind and 50% of blind eyes had vitreous hemorrhage. Since Indocyanine Green Angiography is the most appropriate imaging technology and is mostly unavailable in Nigeria, efforts should be made to address this need and improve the diagnostic accuracy.
Topics: Adult; Aged; Aged, 80 and over; Choroid; Cross-Sectional Studies; Female; Fluorescein Angiography; Humans; Male; Middle Aged; Nigeria; Retrospective Studies; Tomography, Optical Coherence
PubMed: 34531344
DOI: 10.4103/njcp.njcp_682_20 -
Current Diabetes Reports Oct 2022Intravitreal anti-vascular endothelial growth factor (VEGF) agents are used routinely in the management of neovascular conditions including proliferative diabetic... (Review)
Review
PURPOSE OF REVIEW
Intravitreal anti-vascular endothelial growth factor (VEGF) agents are used routinely in the management of neovascular conditions including proliferative diabetic retinopathy and diabetic macular edema. While the efficacy of anti-VEGF agents has been well-validated, their ocular and systemic adverse events should always be considered and discussed with patients. The aim of this review is to discuss the most recent literature reports regarding the various ocular and systemic adverse events associated with intravitreal anti-VEGF treatment in diabetic retinopathy.
RECENT FINDINGS
The most frequently reported adverse ocular events include subconjunctival hemorrhage, vitreous hemorrhage, increased intraocular pressure, uveitis, endophthalmitis, ocular surface disease, and traumatic cataract. Subconjunctival hemorrhage and vitreous hemorrhage are the most common ocular adverse events reported with intravitreal anti-VEGF treatment. The most serious (though rare) ocular adverse events include endophthalmitis and rhegmatogenous retinal detachment. A consensus regarding the association of systemic adverse events (such as myocardial infarction, stroke, and death) with intravitreal anti-VEGF treatments has not been established. Intravitreal anti-VEGF therapy is used in the treatment of diabetic retinopathy, macular degeneration, and other diseases. These agents are associated with a variety of ocular and systemic adverse events that ophthalmologists should always consider.
Topics: Angiogenesis Inhibitors; Bevacizumab; Diabetes Mellitus; Diabetic Retinopathy; Endophthalmitis; Humans; Intravitreal Injections; Macular Edema; Ranibizumab; Vascular Endothelial Growth Factor A; Vitreous Hemorrhage
PubMed: 36053385
DOI: 10.1007/s11892-022-01491-y -
Journal of Cancer Research and... 2022Pancreatic adenocarcinoma is the seventh largest cause of death from cancer with a death rate of 3.8%. The 5-year survival rate is only 5%. We report A case 28 year old...
Pancreatic adenocarcinoma is the seventh largest cause of death from cancer with a death rate of 3.8%. The 5-year survival rate is only 5%. We report A case 28 year old male presented with a 3 week history of pain in upper part of abdomen and dyspepsia of similar duration. After 2 cycles of palliative chemotherapy he presented with diminution of vision in right eye and watering of eye. USG showed retinal detachment with vitreous hemorrhage in the right eye and left eye was normal. On fundoscopy choroidal metastasis was detected as an accidental finding in the right eye. Though Ca Pancreas usually presents in as locally advanced or metastatic disease choroidal metastasis are extremely rare. Despite disappearance of ocular metastasis he had a progressive disease and died of intraparenchymal hemorrhage. Reports of pancreatic cancer with metastasis to the choroid and optic nerve have been rare. There were few reports that demonstrated the significance of a choroidal lesion as the initial clinical sign of pancreatic cancer. This aggressive behavior of the lesion may be an important feature to determine the origin of the tumor. Cancer of the tail of the pancreas is often not detected in the early stages before metastasizing.
Topics: Adenocarcinoma; Adult; Choroid; Choroid Neoplasms; Humans; Male; Pancreatic Neoplasms
PubMed: 35381796
DOI: 10.4103/jcrt.JCRT_45_20 -
Therapeutic Advances in Ophthalmology 2022Optimal management of non-diabetic vitreous hemorrhage (NDVH) is controversial, and reliability of B-scan ultrasonography in detecting retinal tears (RTs) has been...
BACKGROUND
Optimal management of non-diabetic vitreous hemorrhage (NDVH) is controversial, and reliability of B-scan ultrasonography in detecting retinal tears (RTs) has been reported to be highly variable by previous literature.
OBJECTIVES
To report outcomes of conservative versus surgical management of NDVH and reliability of B-scan ultrasonography in detecting RTs and rhegmatogenous retinal detachment (RRD).
DESIGN
Retrospective observational single-center cohort study.
METHODS
Ninety-six consecutive NDVH from 96 eyes (96 patients) with minimum follow-up duration of 12 months were included.
RESULTS
Seventy-two eyes (75%) underwent early pars plana vitrectomy (PPV), 19 (20%) were managed conservatively and 5 (5%) underwent late PPV. Initial mean best corrected visual acuities (BCVAs) were 1.95 ± 1.19, 1.19 ± 1.38, and 1.14 ± 1.04 logMAR respectively, the difference was statistically significant ( = 0.039). Mean final BCVAs were 0.92 ± 1.19, 0.59 ± 0.87, and 1.25 ± 1.89 logMAR, respectively, the difference was not significant ( = 0.447). When comparing initial and final BCVAs, the difference was significant only in the early PPV group ( = 0.00001) and was not significant in the conservative group ( = 0.066) and in the late PPV group ( = 0.46). Complications included RRD ( = 2) and re-bleed in vitrectomized cavity ( = 1) in the early surgical group, need for additional laser or cryoretinopexy to RTs ( = 2), retinal detachment ( = 1), neovascular glaucoma ( = 1), persistent vitreous hemorrhage ( = 2) in the conservative group. B-scan ultrasound showed preoperative 11.53% sensitivity and a 60.0% positive predictive value for diagnosing retinal tears (RTs) in NDVH.
CONCLUSION
The benefit of early PPV in NDVH seems to outweigh the risks of surgery, especially in the context of low sensitivity of B-scan in identifying RTs, and significant improvement in final BCVA following surgery may occur. NDVH should be promptly referred to vitreoretinal services, as surgery may be a safer and more advisable option.
PubMed: 35510165
DOI: 10.1177/25158414221090099 -
Survey of Ophthalmology 2023X-linked retinoschisis (XLRS) is an X-linked inherited retinal dystrophy characterized by mild-to-severe visual impairment, splitting of the retinal layers, and a... (Review)
Review
X-linked retinoschisis (XLRS) is an X-linked inherited retinal dystrophy characterized by mild-to-severe visual impairment, splitting of the retinal layers, and a reduction in the dark-adapted b-wave amplitude on the electroretinogram. Typical clinical features include macular and peripheral schisis. Relatively common features reported include rhegmatogenous or tractional retinal detachment, vitreous hemorrhage, retinal pigment epithelial changes, vitreous veils, and various retinal vascular abnormalities with or without exudation. Macular hole and macular folds are atypical presentations of XLRS, along with several other rare findings. Here, we report 4 cases of XLRS with atypical clinical presentations and review the literature on XLRS, with a focus on the variable clinical features of this condition.
Topics: Humans; Retinoschisis; Retinal Detachment; Retina; Electroretinography; Vitreous Hemorrhage; Tomography, Optical Coherence
PubMed: 36724832
DOI: 10.1016/j.survophthal.2023.01.008 -
The Journal of Emergency Medicine Mar 2023Spontaneous hyphema is the rare occurrence of hemorrhage within the anterior chamber of the eye without a predisposing traumatic event. Hyphema can be associated with...
BACKGROUND
Spontaneous hyphema is the rare occurrence of hemorrhage within the anterior chamber of the eye without a predisposing traumatic event. Hyphema can be associated with acute elevations in intraocular pressure in up to 30% of cases, which poses a significant risk for permanent vision loss if not quickly recognized and treated in the emergency department (ED). Anticoagulant and antiplatelet medications have been previously associated with cases of spontaneous hyphema; however, there are limited reports of hyphema with associated acute glaucoma in a patient taking a direct oral anticoagulant. Due to the limited data of reversal therapies for direct oral anticoagulants in intraocular hemorrhage, these patients pose a challenge in deciding whether to reverse anticoagulation in the ED.
CASE REPORT
We present a case of a 79-year-old man on apixaban anticoagulation therapy who presented to the ED with spontaneous painful vision loss in the right eye with associated hyphema. Point-of-care ultrasound revealed an associated vitreous hemorrhage, and tonometry was significant for acute glaucoma. As a result, the decision was made to reverse the patient's anticoagulation with four-factor activated prothrombin complex concentrate. Why Should an Emergency Physician Be Aware of This? This case is an example of acute secondary glaucoma due to a hyphema and vitreous hemorrhage. There is limited evidence regarding anticoagulation reversal in this setting. A second site of bleeding was identified by utilization of point-of-care ultrasound, which led to the diagnosis of a vitreous hemorrhage. This allowed for shared decision-making between the emergency physician, ophthalmologist, and patient regarding the risks and potential benefits of the reversal of anticoagulation. Ultimately, the patient decided to have his anticoagulation reversed to try and preserve vision.
Topics: Male; Humans; Aged; Hyphema; Vitreous Hemorrhage; Anticoagulants; Hemorrhage; Glaucoma
PubMed: 36863910
DOI: 10.1016/j.jemermed.2022.12.021 -
Trauma Case Reports Feb 2022This study examined the treatment, clinical course, and prognosis of two patients who visited our institution with severe ocular fishhook-related injuries with...
UNLABELLED
This study examined the treatment, clinical course, and prognosis of two patients who visited our institution with severe ocular fishhook-related injuries with complications. The first patient was a 57-year-old man injured in the right eye by a fishhook lacerating the right upper eyelid. Although no aqueous humor leakage was observed, intraocular hemorrhage was severe, and the best-corrected visual acuity (BCVA) was "counting fingers" at 15 cm. The eyelid was sutured and vitreous surgery with cataract surgery was performed for traumatic cataract, vitreous hemorrhage, and retinal detachment. The patient experienced recurring iritis and the BCVA recovered to 20/100 eight months postoperatively. The second patient was a 62-year-old man who incurred a penetrating right-eye fishhook injury on a ship with BCVA of "hand motion." The sclera and iris were ruptured with severe hemorrhage and a shallow anterior chamber without leakage of aqueous humor. A damaged lens and vitreous hemorrhage were observed with intraocular pressure of 38 mmHg. The ruptured sclera was sutured and vitreous surgery with lensectomy was performed. After 16 months, the BCVA improved to 20/40; however, glaucoma control was maintained by topical medication. Therefore, ocular fishhook-related injury could result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing.
PLAIN LANGUAGE SUMMARY
There are few reports on fishhook injury of the eye with resulting complications such as retinal detachment. We present the characteristics of the injury, treatment, clinical course, and prognosis of two patients with severe fishhook-related injuries of the eye with complications. Following treatment, most complications, including vitreous hemorrhage, detached lens, and retinal detachment, safely resolved in these cases; however, both patients required further treatment for recurring inflammation of the iris or glaucoma. The visual acuity of both patients improved over several months. Fishhook-related injuries of the eyes might result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing.
PubMed: 34917740
DOI: 10.1016/j.tcr.2021.100574 -
Korean Journal of Ophthalmology : KJO Jun 2023To predict the presence of tractional retinal detachment (TRD) in eyes with dense vitreous hemorrhage (VH) and proliferative diabetic retinopathy (PDR) by evaluating the...
PURPOSE
To predict the presence of tractional retinal detachment (TRD) in eyes with dense vitreous hemorrhage (VH) and proliferative diabetic retinopathy (PDR) by evaluating the status of posterior vitreous detachment (PVD) in fellow eyes using optical coherence tomography (OCT).
METHODS
A total of 44 eyes from 22 patients who underwent vitrectomy due to dense VH with PDR were enrolled. Using OCT, the PVD status in the fellow eye was divided into two groups (incomplete and complete PVD). The incomplete PVD group included eyes without PVD and eyes with partial PVD. B-scan ultrasonography was performed on eyes with dense VH to evaluate the presence of TRD. Both OCT and B-scan images were reviewed by four ophthalmologists (two novices and two experienced), and the interobserver agreement was evaluated.
RESULTS
There was a difference in the interobserver agreement regarding the presence of TRD in eyes with dense VH evaluated by B scan between novice and experienced ophthalmologists (novice, κ = 0.421 vs. experienced, κ = 0.814), although there was no difference between novice and experienced ophthalmologists in the interobserver agreement regarding the status of PVD in the fellow eye evaluated by OCT (novice, κ = 1.000 vs. experienced, κ = 1.000). All observed TRD during vitrectomy occurred in eyes with incomplete PVD in the fellow eye. Logistic regression analysis revealed a statistically significant relation between TRD and the age of the patient (odds ratio [OR], 0.874; p = 0.047), and between TRD and incomplete PVD in the fellow eye evaluated by OCT (OR, 13.904; p = 0.042).
CONCLUSIONS
Evaluation of the PVD status in the fellow eye using OCT may be a useful predictor for detecting the presence of TRD in eyes with dense VH and PDR.
Topics: Humans; Vitreous Detachment; Vitreous Hemorrhage; Retinal Detachment; Diabetic Retinopathy; Vitreous Body; Diabetes Mellitus
PubMed: 37068834
DOI: 10.3341/kjo.2022.0161