Bilateral Vitreous Hemorrhage Research Articles

Bilateral vitreous and retinal hemorrhage associated with immune thrombocytopenic purpura and systemic lupus erythematosus followed by neovascularization

Abstract Systemic lupus erythematosus (SLE) is known for its diverse clinical manifestations, with hematological problems occasionally overlooked due to mild symptoms. This case report presents a 15-year-old girl with bilateral blurred vision resulting from severe retinal and vitreous hemorrhage secondary to SLE. Following the resolution of hemorrhage, neovascularization developed in one eye and was successfully treated with intravitreous injections of ranibizumab. This case highlights the significance of considering blood dyscrasia disorders in cases of intraocular hemorrhage and underscores the ocular manifestations and potential complications associated with SLE. Timely diagnosis and appropriate management are vital for preserving vision in such cases.

Vitreous hemorrhage in a pregnant woman with a history of simultaneous pancreas and kidney transplantation: A case report

Pregnancy after simultaneous pancreas and kidney transplantation (SPKT) carries a high risk of maternal and fetal complications. We report the case of a 39-year-old woman with three consecutive pregnancies with favorable outcomes after SPKT. Within the first year of SPKT, the patient had a spontaneous pregnancy. At 32weeks of gestation, she underwent an emergency cesarean section (CS) due to severe preeclampsia and HELLP syndrome. The infant was of average birth weight and was transferred to the neonatal intensive care unit for further management. A second unplanned pregnancy occurred almost nine months after the first. The antenatal assessments for fetal growth, blood glucose, and blood pressure were normal throughout follow-up. Early in her pregnancy, the patient developed an uneventful retinopathy of the left eye. At 37weeks of gestation, she underwent an elective CS due to a short inter-pregnancy interval and delivered a healthy baby with an average birth weight. At the age of 39years, the patient had a third unplanned pregnancy. She was diagnosed with seronegative antiphospholipid syndrome. She suffered from bilateral vitreous hemorrhage and was managed successfully with a minimally invasive laser treatment combined with an intravitreal injection of anti-vascular endothelial growth factor during her third trimester. At 35weeks of gestation, the patient presented with labor pain and underwent an emergency CS and delivered a healthy baby with an average birth weight. Pregnancy after SPKT requires a multidisciplinary approach with a careful workup.

Case Report: Intraocular Hemorrhage in a Primary Vitreoretinal Lymphoma Patient Treated With Zanubrutinib

PurposeTo report a case of primary vitreoretinal lymphoma (PVRL) treated with oral zanubrutinib, who had bilateral intraocular hemorrhage after intravitreal injection of methotrexate (MTX).Case reportA 69-year-old Chinese female presented with vision decrease in both eyes. After diagnostic vitrectomy, the patient was diagnosed as PVRL in both eyes, and was treated with intravenous rituximab, oral zanubrutinib and bilateral intravitreal MTX. There were bilateral anterior chamber and vitreous hemorrhage after the fourth intravitreal MTX combined with paracentesis. After discontinuation of zanubrutinib, vitrectomy and silicon oil tamponade were performed on the left eye, and the blood in the right eye was absorbed.ConclusionBleeding is a major concern in the use of zanubrutinib. It is suggested that drugs be held for a few days prior to procedures and surgeries.

Bilateral vitreous hemorrhage with branch retinal vein occlusion secondary to hyperhomocysteinemia: A rare case report

Retinal vascular occlusions are uncommon in young people and require more in-depth investigation into the cause. A high level of circulating homocysteine carries a risk for retinal vaso-occlusive events. We, hereby, report a rare case of hyperhomocysteinemia-related bilateral branch retinal vein occlusion (BRVO). A 27-year-old male presented with sudden painless gross diminution of vision in the left eye (LE) for 10 days. Further assessment revealed inferotemporal BRVO (ITBRVO) in the right eye (RE) with mild vitreous hemorrhage (VH) and dense VH in the LE. Extensive investigations into the cause revealed an elevated level of serum homocysteine. The patient was started on Vitamin B6 and B12 supplementation. RE sectoral panretinal photocoagulation and LE pars plana vitrectomy were done. LE ITBRVO was noted intraoperatively for which endolaser was done. Hyperhomocysteinemia through its prothrombotic properties is an independent modifiable risk factor for vascular thrombotic events. Hence, it should be considered as a differential diagnosis for retinal vascular occlusions to prevent further recurrences and cerebrovascular events, especially in young adults.

Acute Myeloid Leukaemia with Vitreous Haemorrhage: Management Challenge in a Third World Country

Abstract Casestudy Leukaemic ophthalmopathy is commoner in acute myeloid leukaemias. Ophthalmic involvement in leukaemias is classified into: Primary or Secondary. Methods A 35-year-old man with history of working in an oil and gas company for 3years who presented 9months ago on account of one month history of recurrent fever, occasional bone pain and generalised body weakness.Had associated history of passage of dark coloured urine, mouth ulcers, mouth bleeds and dizziness. CBC at presentation showed WBC of 102,300/mcl with 79% blasts, hemoglobin of 5.4g/dL, platelet count of 12,000/mcl. Symptoms were consistent with leukostasis, and he had leukoreduction with exchange blood transfusion and hydroxyurea. Bone marrow aspirate confirmed the diagnosis of AML FAB M2. Bone marrow biopsy showed hypercellular marrow with increased myeloid series, other series depressed. Three days after admission, he complained of painless blurred vision bilaterally and feeling of objects appearing reddish, a review by ophthalmologist with an assessment of bilateral retinal haemorrhage secondary to AML. B – Scan done showed whitish elevated hyperechoic mass (parapapillary) with moderate dot echoes in the vitreous bilaterally. They planned for dilated fundoscopy and advised haematologist to commence chemotherapy as planned. He then had standard induction with cytarabine and daunorubicin.Post chemotherapy showed pancytopenia secondary to chemotherapy. Further review by Ophthalmologist showed bilateral vitreous haemorrhage secondary to bilateral choroidal mass and then planned for vitrectomy and also had bilateral intravitreal bevacizumab Day 14 bone marrow exam showed hypocellularity with absence of blasts indicating remission. He subsequently underwent cycle 1 of consolidation with high-dose cytarabine with the goal to proceed with allogeneic hematopoietic stem cell transplant (HSCT). Post consolidation, patient has had surgeries of both eyes and subsequently regained full vision in both eyes. Though patient is yet to re-present for post consolidation chemotherapy despite adequate counsel due to financial constraints and yet to have allogeneic hematopoietic stem cell transplant (HSCT) and last showed up for follow up four months ago. Results Patient regained full vision in both eyes Conclusion This case illustrates that vitreous haemorrhage in Patients with AML can be effectively managed in a resource limited setting.

Retracted: An Unusual Case of Bilateral Vitreous Haemorrhage following Snake Bite.

[This retracts the article DOI: 10.1155/2013/640582.].

A rare presentation of Potassium Iodate toxicity

Introduction Potassium Iodate is a compound used for nutritional supplementation in table salt and administered to individuals exposed to radioactive iodine. Toxicity to Potassium Iodate is not a common presentation to the emergency room. In this case report, we present a young man who was brought to the ED after deliberate oral ingestion of Potassium Iodate, who then had a remarkable clinical course in the hospital. Case description A 26-year-old Sri Lankan male was referred to the Emergency department as a case of ST elevation MI from the primary health centre, where he had presented with diarrhoea. In the Emergency, he admitted to have consumed a handful of potassium iodate powder, 17 hours prior to presentation to ED, as an act of deliberate self-harm. He then had complains of cramping abdominal pain, loose stools and vomiting. He was also complaining of visual disturbances, in the form of seeing everything with a greyish tinge. On initial assessment of patient, he was talking, with a patent airway, had no evidence of any respiratory distress and had stable haemodynamics and GCS of 14/15. Visual acuity was 6/6 but stated everything appears grey. ECG showed ST elevation and tall T waves in chest leads, reciprocal changes of ST depression in III, aVF with prolonged PR and QRS interval. Echocardiogram was done which showed no regional wall motion abnormality. Labs showed high potassium (K-7.6meq/L). Other notable results were CPK of 3909U/L, myoglobin more than 5000ng/ml, high sensitive Troponin T - 220ng/L, Troponin I - 1.8ng/L, Leukocytosis of 34500/uL with neutrophilia, creatinine - 226umol/L, BUN - 6.07mmol/L, Sodium - 139meq/L, mixed respiratory and metabolic acidosis with normal anion gap and osmolar gap. Fibreoptic laryngoscopy looking for any features of corrosive damage to upper airway proved normal. Over few hours he developed methhaemoglobenaemia. Treatment was started for hyperkalemia but only had transient response to repeated medical management. Emergency hemodialysis was started to treat the hyperkalaemia. He was later admitted under the intensive care with input from renal team. He received hemodialysis for more than 3 weeks. He was also found to have only light perception in both eyes with bilateral vitreous hemorrhage and posterior vitreous detachment. Patient as of date has started to pass urine. He is off hemodialysis. He still has renal failure and is continuing treatment in the medical floor. Conclusion Though renal failure, hyperkalemia and retinopathy have been described in literature, the presentation and clinical course of this patient were unique in many ways including severe rhabdomyolysis leading to acute tubular necrosis and bilateral vitreous hemorrhage with posterior vitreous detachment.

A Neonate with Bilateral Vitreous Hemorrhages After Intra-uterine Bowel Infarction Secondary to Volvulus

Vitreous hemorrhages are uncommon in the neonatal period. This article describes a neonatal who had bilateral vitreous hemorrhages after intrauterine bowel infarction.

Early Postnatal Hyperoxia in Mice Leads to Severe Persistent Vitreoretinopathy.

To describe a mouse model of hyperoxia-induced vitreoretinopathy that replicated some of the clinical and pathologic features encountered in infants with severe retinopathy of prematurity and congenital ocular conditions such as persistent hyperplastic primary vitreous. Experimental mice (C57BL/6J) were exposed to 65% oxygen between postnatal days (P)0 to P7 and studied at P10, P14, and 3, 5, 8, 20, and 40 weeks. Controls were exposed to normoxic conditions. Fundus imaging and fluorescein angiography were performed at all time points, and spectral-domain optical coherence tomography (SD-OCT) and electroretinography were performed at 8- and 20-week time points. Eyes were processed for resin histology, frozen sections, and retinal whole mounts. Immunostaining was performed to visualize vasculature isolectin B4 (Ib4), collagen type IV, glial fibrillary acidic protein, and α-smooth muscle actin. Early exposure to hyperoxia resulted in bilateral vitreous hemorrhages at 3 weeks. From 5 weeks onward there were extensive zones of retinal degeneration, scarring or gliosis, retinal folding, and detachments caused by traction of α-smooth muscle actin-positive vitreous membranes. Tortuous retinal vessels, together with hyperplastic and persistence of hyaloid vessels are evident into adulthood. In the early stages (P10-3 weeks), branches from the tunica vasculosa lentis (TVL) supplied the marginal retina until retinal vessels were established. The peripheral retina remained poorly vascularized into adulthood. Electroretinography revealed 50% to 60% diminution in retinal function in adult mice that strongly correlated with vitreal changes identified using SD-OCT. This animal model displays a mixture of vitreoretinal pathologic changes that persist into adulthood. The model may prove valuable in experimental investigations of therapeutic approaches to blinding conditions caused by vitreous and retinal abnormalities.

Peter's anomaly in twins: a rare incidence with novel associations

PurposePeter's anomaly is a rare developmental malformation involving the anterior segment of the eye culminating in congenital blindness, with or without systemic associations. herein, we report an incidence of this anomaly in twins with novel associations.MethodsChart review, clinical and radiological assessment.ResultsThe probands are 2 year old Saudi boys (twin I and twin II) born to consanguineous mates at 36 weeks following uneventful pregnancy. On examination: both twins were not blinking in response to light and were not able to fixate and follow a moving object with prominent horizontal nystagmus. Slit lamp examination demonstrated varying degrees of central leukoma (corneal opacity) associated with iridocorneal adhesion characteristic of type I peter anomaly in both twins. No catarctous changes were observed. A normal intraocular pressure with intact retinas were seen in both twins. Striking pupillary abnormalities include bilaterally underdeveloped pupil (twin I) and bilateral absence of the pupil (twin II). Ocular ultrasound: revealed bilateral vitreous hemorrhage mostly linked to deranged coagulation. Ocular MRI: showed bilateral microophtalmia and optic nerves hypoplasia with small optic chiasm in both twins. Systemic associations: both twins have coarse facial features and a thrombophilia state secondary to homozygous protein C deficiency; a rare thrombotic condition seen in 1\4,000,000 live birth. Twin II developed bilateral inguinal hernia and cryptorchidismConclusionsThe novel concordance of peter's anomaly in these twins is probably an emerging evidence supporting the genetic basis of this defect. Optic nerve and optic chiasm hypoplasia along with the severe protein C deficiency and bilateral absence of the pupil are all important associations which have never been reported previously with this anomaly.

Terson's Syndrome: a frequently missed ophthalmologic finding in subarachnoid hemorrhage

Terson's syndrome is vitreous hemorrhage occurring consequent to subarachnoid hemorrhage. We present here the case of 60 years old male person who met with road traffic accident. He was transported to a hospital where diffuse subarachnoid hemorrhage was diagnosed radiologically. But before further studies could be Pursued, and surgical intervention started, his condition deteriorated and he died. The autopsy demonstrated diffuse subarachnoid hemorrhage of the brain with bilateral vitreous hemorrhage. Terson's syndrome is certainly an indicator of increased risk of mortality without early surgical attention. This paper reports here radiological and autopsy findings of such case and recommends further studies to estimate of the frequency of vitreous hemorrhage in patients with subarachnoid hemorrhage, and to compare its mortality in patients with and without vitreous hemorrhage. It also recommends the forensic pathologists to assess the vitreous hemorrhage in all cases of subarachnoid hemorrhage with aneurysmal or traumatic brain injury.

Ocular cysticercosis with vitreous hemorrhage: a rare complication of a common disease.

IntroductionCysticercosis, a helminthic infestation caused by Taenia solium, can produce central nervous system, muscles, visceral, subcutaneous tissues and skin manifestations. Ophthalmological involvement can affect eyelids, conjunctiva, anterior chamber, uvea, vitreous, retina, extraocular muscles and optic nerve. Simultaneous co-occurrence of intracranial and intraocular cysticercosis is a common presentation in clinical practice.Case descriptionWe report a case of young girl who was diagnosed with multiple intracranial neurocysticercosis lesions and was on antiepileptic drugs, following which she presented with progressive painless vision loss from both the eyes. Indirect ophthalmoscopic examination showed evidence of subretinal cysts, retinal hemorrhage and retinal detachment in both the eyes. Surprisingly, bilateral vitreous hemorrhage was also detected. Ocular B-scan ultrasonography, orbital MRI and computed tomography revealed retinal detachment with vitreous hemorrhage in both the eyes. Magnetic resonance imaging (MRI) of brain showed multiple intraparenchymal small cystic lesions in bilateral cerebral and cerebellar hemispheres, basal ganglia, thalami and brainstem.ConclusionsVitreous and retinal detachment are well known complications of intraocular cysticercosis, however, vitreous hemorrhage as preoperative feature has never been reported before, although vitreous hemorrhage as postoperative complication is common.

Bilateral Vitreous Hemorrhage in Children: Clinical Features and Outcomes.

Purpose:To determine the etiology, clinical features and outcomes of bilateral vitreous hemorrhage (VH) in children.Methods:This retrospective chart review was performed on patients with bilateral VH under the age of 18 at a tertiary eye care center in India. Data included demographics, details of history and ocular examination, reports of investigations, surgeries or other interventions performed, and final anatomical and visual outcomes. Patients were divided into two groups i.e., traumatic and non-traumatic (spontaneous).Results:The traumatic group was comprised of 37 patients including 27 male and 10 female subjects with mean age of 13.47 ± 5.31 years, the most common complaint was decreased vision (96.45%) and the most prevalent etiology was firecracker injury in 16 (43.2%) patients. Mean baseline visual acuity (VA) was 2.34 ± 1.31 logMAR which was significantly improved to 1.08 ± 0.23 logMAR (P = 0.042). The mean number of surgeries was 2.72 ± 1.43 in the traumatic VH and mean follow up period was 23.14 ± 6.54 months. The spontaneous group included 48 subjects comprised of 27 male and 21 female cases with mean age of 14.48 ± 2.03 years. The most common cause was vasculitis in 21 (43.75%) subjects including four patients with tuberculosis. Mean baseline VA was 1.97 ± 1.13 logMAR which showed a significant improvement to 0.82 ± 0.24 logMAR (P = 0.012) after mean follow up of 34.2 ± 11.2 months. Eleven patients required at least one major surgery.Conclusion:Vasculitis was the most common cause of spontaneous bilateral VH; traumatic VH most prevalently occurred due to firecracker injury. Final VA was better in the spontaneous group.

Spontaneous Vitreous Hemorrhage in Children

To determine the clinical profile, causes, and outcomes of "spontaneous" vitreous hemorrhage in children (<18 years). Retrospective computer-assisted chart review. Charts of 124 eyes of 76 children who presented with nontraumatic, nonsurgical vitreous hemorrhage between 2002 and 2012 were reviewed. All children underwent an appropriate ocular and systemic examination. Data collected included demographics, visual acuity, cause of "spontaneous" vitreous hemorrhage, ocular and systemic findings at presentation and at last follow-up, investigations, management details, and visual outcomes. The median age was 153.45 ± 56.19months. There were 39 female and 37 male patients. Forty-eight patients had bilateral vitreous hemorrhage. The most common presenting complaints were diminished vision (96.45%) and behavioral changes (87.24%). The mean baseline BCVA in logMAR was 2.25 ± 1.11. The most common causes included vasculitis (34.6%) and hematologic disorders (27.4%). Patients were given medical therapy (topical and/or systemic) or underwent laser photocoagulation (29%) and/or surgery (55.6%). Twenty-nine eyes (23.3%) did not require any intervention. The mean number of surgeries was 1.89 ± 1.45 (range 1-4 surgeries). The mean final visual acuity was 0.76 ± 0.58 logMAR and was significantly better than the baseline (P < .001). The best anatomic and visual outcomes were seen in vasculitis, whereas congenital disorders such as retinoschisis had the worst. Spontaneous pediatric vitreous hemorrhage has a diverse etiology, vasculitis being the most common cause in our series. A comprehensive evaluation (systemic and ocular) is required to ensure that vision- and life-threatening conditions are not missed.

Laser Photocoagulation in Patients With Retinopathy of Prematurity Undergoing Chest Physiotherapy

The authors report the correlation between chest physiotherapy and increased risk of vitreous hemorrhage after laser photocoagulation therapy in patients with retinopathy of prematurity (ROP). Two premature neonates, the first born at 26 weeks and the second at 31 weeks gestational age, both underwent chest physiotherapy, the first for congenital cystic fibrosis and bronchopulmonary dysplasia and the second for premature alveolar atelectasis. Both were diagnosed as having ROP that necessitated laser photocoagulation treatment at 34 and 37 weeks, respectively. The first patient developed bilateral vitreous hemorrhage and bilateral cataracts. The second patient developed vitreous hemorrhage in one eye. Chest physiotherapy in neonates with ROP significantly increases the risk of hemorrhage after laser photocoagulation in an otherwise fragile retinal vasculature.

An Unusual Case of Bilateral Vitreous Haemorrhage following Snake Bite

A-45-year-old man presented to us with diminution of vision in both eye following snake bite. On examination vision in the right eye (RE) was 6/36 and vision in left eye (LE) was hand movement positive and fundus examination revealed a subhyloid haemorrhage, left eye showed vitreous haemorrhage. Patient was advised bed rest, vitamin C tablets and oral steroids.

Poster 33 Unique Presentation of Terson's Syndrome in a Traumatic Brain Injury Patient: A Case Report

Disclosures: J. W. Bailey, Employment: Temple University Hospital. Case Description: A 30-year-old man sustained a right frontal lobe contusion, subdural hematoma, and subarachnoid hemorrhage following a high-speed motorcycle collision. He was initially comatose and required a decompressive craniectomy for elevated intracranial pressure. After regaining consciousness during his acute hospital course, no visual deficits were identified. Neuroimaging studies revealed no evidence of ocular abnormalities. On admission to our inpatient rehabilitation unit 2 weeks post-injury, baseline visual field testing uncovered binasal hemianopsia. Due to the extremely rare incidence of this pattern and our concerns about the specific anatomic aberrations often required for its manifestation, ophthalmology was consulted immediately. Fundoscopic examination revealed bilateral vitreous hemorrhage. Setting: Tertiary care hospital and rehabilitation facility. Results or Clinical Course: Further evaluation by a retina specialist confirmed the diagnosis of Terson’s syndrome. Given the extent of hemorrhage and the low likelihood of spontaneous resorption, the patient first underwent early left vitrectomy at 5 weeks post-injury. After discharge from our facility, a right vitrectomy was performed. At outpatient physiatry follow-up 4 months post-injury, the patient was noted to have full recovery of vision in both eyes. Discussion: Terson’s syndrome was originally defined by the occurrence of vitreous hemorrhage in association with subarachnoid hemorrhage, but now encompasses any intraocular hemorrhage associated with intracranial hemorrhage and elevated intracranial pressure. Typically, patients present with global vision loss of varying degrees. This is the first reported case, to our knowledge, of binasal hemianopsia associated with Terson’s syndrome. Conclusions: A thorough baseline neurologic examination for patients with traumatic brain injury is necessary to identify deficits such as vision loss. Early recognition and treatment of Terson’s syndrome in this unique case prevented permanent visual impairment and allowed for maximum functional recovery with improved quality of life.

Bilateral vitreous hemorrhage in a newborn with Stickler syndrome associated with a novel COL2A1 mutation

Bilateral preretinal and vitreous hemorrhages in infants are rare and can present a diagnostic challenge, with nonaccidental trauma included in the differential diagnosis. We present the case of a 4-week-old boy in which a Pierre Robin sequence and a positive family history led to the clinical diagnosis of Stickler syndrome, which was confirmed by the identification of a disease-causing novel deletion of 2 nucleotides in the COL2A1 gene. This early association with Stickler syndrome has not been described previously.

Vitrectomy and Internal Limiting Membrane Peeling for Bilateral Vitreous and Sub-ILM Hemorrhages Associated with Trauma

Objective: To evaluate the surgical outcomes of vitrectomy and internal limiting membrane (ILM) peeling in a case of bilateral vitreous hemorrhage and sub-ILM hemorrhages following head injury in a 17-year-old boy. Methods: A 17-year-old boy presented with diminution of vision since 20 days following head injury with loss of consciousness. There was no history of direct ocular trauma. BCVA was 1/60 in right eye and finger counting close to face (FCCF) in left eye. Fundus examination revealed vitreous hemorrhage obscuring retinal details in both eyes. Computed tomography (CT) scan did not reveal any intracranial hemorrhage but was suggestive of neuronal contusion. Hence, the diagnosis of Terson's syndrome could not be confirmed. Ultrasound scan showed mild thickening of retinochoroidal coats in macular area and few vitreous echoes suggestive of premacular hemorrhage, bilaterally. Flash VEP showed reduced amplitude with normal P2 latency, in both eyes. The patient underwent 23 G TSV (trans-scleral sutureless vitrectomy), ILM peeling and evacuation of sub-ILM blood in both eyes. Results: Six weeks after surgery, both eyes revealed healthy macula; BCVA improved to 6/6, N6. Multifocal ERG revealed minimally reduced central ring responses in right eye and normal ring responses in left eye. Microperimetry showed normal mean retinal sensitivity in both eyes. Conclusion: Early vitrectomy with ILM peeling in case of sub-ILM hemorrhages secondary to trauma allows complete aspiration of the hemorrhages and may help in early and better visual recovery.

Ocular sarcoidosis and tuberculous lymphadenopathy: coincidence or real association

Tuberculosis and sarcoidosis share similarity in histopathologic findings and clinically occur in association with each other occasionally. Tuberculosis should always be ruled out before the diagnosis of sarcoidosis. But, the diagnosis is often complicated, especially in extrapulmonary cases. Here we present a case of bilateral vitreous hemorrhage with uveitis. Ocular sarcoidosis was initially diagnosed based on the characteristic ocular findings, negative results on chest radiography, tuberculosis culture, and polymerase chain reaction of aqueous, as well as simultaneous presence of panda and lambda sign on gallium-67 scans. The ocular condition improved after pars plana vitrectomy and systemic steroid therapy. However, TB lymphadenopathy but no recurrent ocular inflammation was found 6 years later. The patient received anti-TB treatment for 6 months thereafter. The eyes remained silent except cataract progression and glaucoma under two medications during this period. In conclusion, TB could occur coincidently or in association with sarcoidosis, continued follow-up is important for patients with ocular sarcoidosis.