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Eye Pain During Hemodialysis in Severe Proliferative Diabetic Retinopathy With Neovascular Glaucoma.Journal of Vitreoretinal Diseases 2024To report a case of severe eye pain developing during dialysis. A case report was performed. A 41-year-old man with uncontrolled type 2 diabetes and end-stage...
To report a case of severe eye pain developing during dialysis. A case report was performed. A 41-year-old man with uncontrolled type 2 diabetes and end-stage nephropathy developed severe pain in the left eye during hemodialysis. A decline in vision in both eyes was reported over the preceding year, with blindness in the left eye for 6 months. The best-corrected visual acuity was 20/150 OD and light perception OS. The intraocular pressure was 14 mm Hg and 59 mm Hg, respectively. An examination found disc neovascularization with a "volcanic eruption" of vitreous hemorrhage from the optic nerve in the right eye and significant corneal edema and iris neovascularization with no posterior view in the left eye. The patient required urgent cyclophotocoagulation for neovascular glaucoma (NVG) in the left eye, bilateral antivascular endothelial growth factor injections, and panretinal photocoagulation in the right eye for proliferative diabetic retinopathy. Worsening eye pain during hemodialysis in a patient with NVG indicates severely limited outflow capacity and requires immediate intervention.
PubMed: 38465365
DOI: 10.1177/24741264241230147 -
The Journal of International Medical... Mar 2024Terson syndrome refers to intraocular haemorrhage that occurs due to subarachnoid bleeding associated with an acute increase in intracranial pressure. No previous study... (Review)
Review
Terson syndrome refers to intraocular haemorrhage that occurs due to subarachnoid bleeding associated with an acute increase in intracranial pressure. No previous study has reported a delayed macular hole (MH) secondary to Terson syndrome. A 17-year-old boy visited our department and presented with vitreous bleeding and a history of subarachnoid haemorrhage. Sub-internal limiting membrane (ILM) haemorrhage with ILM detachment and intraretinal haemorrhage were detected during pars plana vitrectomy. Additionally, a delayed MH was detected 1 week after the surgery. There was no sign of MH closure during a 2-month follow-up. Subsequently, an MH massage was performed to close the MH. Our findings suggest that a delayed MH can occur secondary to Terson syndrome. Elevated hydrodynamic pressure and hydrostatic pressure, which are caused by sub-ILM and intraretinal haemorrhages of the fovea, contribute to the formation of an MH. Additionally, ILM peeling may cause damage to the macula and facilitate the formation of MHs. Although the MH may close by itself, early surgical intervention is recommended when there is no sign that the MH will close spontaneously because a prolonged MH can lead to retinal damage.
Topics: Male; Humans; Adolescent; Retinal Perforations; Visual Acuity; Macula Lutea; Retina; Vitrectomy; Vitreous Hemorrhage; Retrospective Studies
PubMed: 38460551
DOI: 10.1177/03000605241233125 -
Retina (Philadelphia, Pa.) Jul 2024To evaluate the outcomes and prognostic factors of pars plana vitrectomy combined with subretinal injection of recombinant tissue plasminogen activator for submacular...
PURPOSE
To evaluate the outcomes and prognostic factors of pars plana vitrectomy combined with subretinal injection of recombinant tissue plasminogen activator for submacular hemorrhage (SMH) patients with or without vitreous hemorrhage (VH).
METHODS
Sixty-four eyes of 64 patients with SMH underwent pars plana vitrectomy with subretinal injection of recombinant tissue plasminogen activator. Best-corrected visual acuity, SMH displacement, and postoperative complications were analyzed. Predictive factors of the final best-corrected visual acuity were determined using multivariant linear regression.
RESULTS
There were 26 eyes with VH and 38 eyes without VH best-corrected visual acuity significantly improved in both VH group (from 2.27 ± 0.40 to 1.25 ± 0.70 logarithm of the minimum angle of resolution) and non-VH group (from 1.76 ± 0.55 to 0.85 ± 0.65 logarithm of the minimum angle of resolution). Complete displacement of SMHs was observed in 47 (73.43%) eyes. Postoperative complications included recurrent SMH (4.69%), recurrent VH (10.94%), rhegmatogenous retinal detachment (3.13%), and epiretinal membrane (4.68%). Treatment-naive condition, early surgery, and younger age were significantly associated with better final best-corrected visual acuity ( B = 0.502, 0.303, and 0.021, respectively, with all P < 0.05).
CONCLUSION
Pars plana vitrectomy combined with subretinal recombinant tissue plasminogen activator injection is an effective treatment for SMH patients with and without VH.
Topics: Humans; Vitrectomy; Tissue Plasminogen Activator; Male; Female; Visual Acuity; Retinal Hemorrhage; Aged; Middle Aged; Fibrinolytic Agents; Retrospective Studies; Vitreous Hemorrhage; Injections, Intraocular; Tomography, Optical Coherence; Recombinant Proteins; Adult; Follow-Up Studies; Treatment Outcome
PubMed: 38452260
DOI: 10.1097/IAE.0000000000004093 -
Arquivos Brasileiros de Oftalmologia 2024This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous...
PURPOSE
This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy.
METHODS
This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed.
RESULTS
Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up.
CONCLUSIONS
The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications.
Topics: Humans; Diabetic Retinopathy; Vitreous Hemorrhage; Retrospective Studies; Hemorrhage; Eye; Diabetes Mellitus
PubMed: 38451685
DOI: 10.5935/0004-2749.2022-0334 -
Vestnik Oftalmologii 2024The article presents a clinical case of bilateral Terson syndrome caused by the manifestation of acute myeloid leukemia. A 32-year-old man complained of a sharp decrease...
The article presents a clinical case of bilateral Terson syndrome caused by the manifestation of acute myeloid leukemia. A 32-year-old man complained of a sharp decrease in vision in both eyes. Spontaneous subarachnoid hemorrhage occurred secondary to acute myeloid leukemia. Uncorrected visual acuity (UCVA) amounted to OD=0.01, OS=0.005. The anterior segment was normal in both eyes, voluminous immobile white-gray mass measuring 7-9 DD that completely covered the macula (intense hyperechoic cell suspension with a volume of about / of the vitreous cavity, ultrasound B-scan) were visualized in the posterior pole of the vitreous body of both eyes under conditions of maximum drug-induced mydriasis. Diagnosis: vitreous hemorrhage due to subarachnoid hemorrhage in both eyes secondary to acute myeloid leukemia. Vitrectomy was performed in both eyes. UCVA increased to 0.05 in both eyes. Vitrectomy contributed to improvement of visual functions and patient quality of life.
Topics: Male; Humans; Adult; Vitreous Hemorrhage; Quality of Life; Vitreous Body; Leukemia, Myeloid, Acute; Vitrectomy
PubMed: 38450469
DOI: 10.17116/oftalma202414001172 -
Ophthalmology. Retina Mar 2024To evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy (PPV) for complications of proliferative diabetic...
OBJECTIVE
To evaluate clinical characteristics impacting surgical outcomes of patients undergoing pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy (PDR).
DESIGN
Retrospective consecutive observational case series of patients at a large county hospital in Dallas, Texas, from 2014 to 2019.
SUBJECTS
Seven hundred thirty-two patients (933 eyes) undergoing PPV for PDR complications.
METHODS
Collected data included demographics, surgical indication, adjuvant therapies, intraoperative course, complications, and best corrected visual acuity (BCVA). Patients with < 6 months of follow-up were excluded. Best corrected visual acuity was converted to logarithm of the minimum angle of resolution for analysis. Statistics performed included t test, analysis of variance, and multivariate analyses.
MAIN OUTCOME MEASURES
Postoperative BCVA, primary anatomic success rate, and postoperative complications.
RESULTS
Three hundred ninety-three patients were male (509 eyes; 54.5%) with an average age of 52 years. Postoperative BCVA at 6 months was significantly different among surgical indications: 0.79 versus 0.77 versus 1.20 (P < 0.0001) for vitreous hemorrhage (VH), vitreomacular interface abnormalities, and tractional retinal detachment (TRD), respectively. Adjuvant preoperative therapy with panretinal photocoagulation (PRP) versus no PRP (0.95 vs. 1.25; P < 0.001) and insulin versus no insulin (0.99 vs. 1.17; P < 0.01) were associated with improved vision. Iatrogenic breaks were associated with decreased postoperative vision (1.40 vs. 0.88; P < 0.001). The primary anatomic success rate for TRD was 85% (495 eyes). Combined TRD/RRD (tractional and rhegmatogenous retinal detachment) was associated with a lower success rate compared with macula-on/macula-off TRD, with odds ratios of 0.36, 0.46, and 0.53, respectively. Patients experiencing recurrent detachment postsurgery had worse preoperative visual acuity (VA) (1.93 vs. 1.63; P < 0.01) and were younger (47.6 vs. 50.0; P = 0.02). Postoperative complications occurred in 699 eyes (75%), with VH (498 eyes, 53%), cataract (465, 50%), and elevated intraocular pressure (149, 16%) being the most common. Two hundred thirty-six eyes (25%) required a second PPV operation. Endophthalmitis (1 eye; <1%) and choroidal detachment (5 eyes; <1%) were rare.
CONCLUSIONS
In this retrospective series analyzing surgical outcomes among patients with complications from PDR, vitrectomy led to improved vision on average, with a meaningful proportion of patients receiving additional surgical intervention. Surgical indication, presenting VA, age, and adjuvant therapies appeared to impact outcomes.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
PubMed: 38447921
DOI: 10.1016/j.oret.2024.02.015 -
BMC Ophthalmology Mar 2024Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage is commonly observed in myopia with tilted optic disc. It presents with typical features on...
BACKGROUND
Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage is commonly observed in myopia with tilted optic disc. It presents with typical features on the fundus and follows a self-limiting course. However, due to its complex etiology, clinicians sometimes lack sufficient understanding of it which can easily lead to misdiagnosis or overtreatment. In this case report, we describe a rare case of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage in both eyes.
CASE PRESENTATION
An 18-year-old female who has no past medical history experienced sudden black shadow blocking of her right eye in the right eye for the past 2 days after a 5-day history of COVID-19 infection. The best corrected visual acuity is 0.5 in the right eye and 0.6 in the left eye. Optical coherence tomography (OCT) showed tilted optic discs in both eyes, bulged nasal optic discs, and the presence of strong reflective material under the parafoveal retina of the optic discs. Fundus fluorescein angiography (FFA) showed subretinal fluorescence occlusion above and nasolateral to the optic disc in the right eye, with hypofluorescence below the optic disc; the subretinal below the optic disc was obscured by vitreous hemorrhage; hypofluorescence was seen in the optic disc region of the left eye.COVID-19 antigen was positive. The patient was in the early stage of the third COVID-19 infection when the disease occurred. We speculate that it may be related to it. After 5 months of conservative treatment, the patient's hemorrhage disappeared in both eyes and her best corrected visual acuity returned to normal.
CONCLUSIONS
Intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage usually occurs in myopia with tilted optic disc. In most patients, the cause of the bleeding is unknown, but it can gradually resolve under clinical observation or conservative treatment.
Topics: Humans; Female; Adolescent; COVID-19; Retinal Hemorrhage; Optic Disk; Myopia; Vitreous Hemorrhage
PubMed: 38439046
DOI: 10.1186/s12886-024-03368-y -
Scientific Reports Mar 2024We evaluated the distribution and types of retinal hemorrhages (RHs) and other damages in eyes with abusive head trauma (AHT). This retrospective, consecutive case...
We evaluated the distribution and types of retinal hemorrhages (RHs) and other damages in eyes with abusive head trauma (AHT). This retrospective, consecutive case series of AHT and non-AHT conditions involved 54 children with AHT, 43 children with head bruises, and 49 children with blunt eye trauma, each of non-AHT supported by reliable witness accounts. RHs and other damage were evaluated using ophthalmoscopy and wide-field fundus photography. A variety of RH types and other damage were identified in the AHT group but not in the non-AHT group. RHs in AHT extended from the posterior pole to the far periphery in 77% of eyes and on/near the veins in 86% and arteries in 85%, most of which were in the far periphery. Retinoschisis, white-dot lesions, and retinal folds were seen even in the far periphery. RHs on/near the veins and arteries, retinoschisis, and retinal folds suggest a traumatic mechanism of the tractional force of the vitreous that is attached to the entire retinal surface. Identifying the distribution and arterio and venous origins of RHs is a key factor in determining the association with trauma. Thus, wide-field fundus photography is useful to record and evaluate the origin of the RHs and other retinal damage.
Topics: Child; Humans; Retinal Hemorrhage; Retinoschisis; Retrospective Studies; Craniocerebral Trauma; Retinal Diseases; Eye Injuries; Retina
PubMed: 38438406
DOI: 10.1038/s41598-024-54664-y -
Radiology Case Reports May 2024Terson's syndrome occurs as a result of intraocular hemorrhage associated with intracranial hemorrhage, but was formerly used to describe vitreous hemorrhage associated...
Terson's syndrome occurs as a result of intraocular hemorrhage associated with intracranial hemorrhage, but was formerly used to describe vitreous hemorrhage associated with Aneurysmal Subarachnoid Hemorrhage (SAH). We present a case of a 36-year-old woman who was not a known hypertensive but presented with a sudden onset of loss of vision in both eyes and a few hours later became deeply unconscious. A computed tomography (CT) scan of the head revealed massive intracerebral hemorrhage with intraventricular extension secondary to severe hypertension and bilateral acute retinal hemorrhages due to the acute rise in intracranial pressure and the recently described ocular glymphatic system provides a novel perspective on the pathophysiology. A diagnosis of Terson's syndrome was made but unfortunately, her clinical condition deteriorated and she expired a few hours after the CT scan. Terson's syndrome is usually associated with poor clinical outcomes from increased intracranial pressure. Implication for clinical practice is that radiologists should critically examine the orbits during imaging for retinal hemorrhage in the setting of severe intracranial hemorrhage for the necessary ophthalmological and neurosurgical interventions to be made since most patients present with sudden onset of loss of vision.
PubMed: 38420340
DOI: 10.1016/j.radcr.2024.01.086