Intraocular Hemorrhage Research Articles

Intraocular foreign body injury in children: clinical characteristics and factors associated with endophthalmitis

Background/AimsTo analyse the clinical characteristics of intraocular foreign body (IOFB) injury in children and evaluate factors associated with endophthalmitis development.MethodsPatients aged <18 years with IOFB attending Zhongshan Ophthalmic Center between...

External Choroidal Drainage Using Direct Visualization.

Laura L. Snyder Shriji N. Patel A woman in her 60s with a functional glaucoma tube shunt presented after vitrectomy for epiretinal membrane peeling with symptomatic choroidal effusions not responsive to medical therapy. She underwent a minimally invasive, transconjunctival choroidal drainage procedure, which was directly visualized under a widefield viewing system to prevent intraocular hemorrhage or retinal penetration of the needle. This allowed for preservation of her conjunctiva, restoration of normal intraocular pressure by temporary blockage of her tube shunt with a viscoelastic, and resolution of her choroidal effusions.

Ocular Melanoma Presenting as Masquerade Syndrome.

A masquerade syndrome is an ophthalmological entity where a neoplasm mimics an inflammatory condition. Ocular melanoma (chiefly uveal) may present with symptoms suggestive of intraocular inflammation such as endogenous endophthalmitis. Ocular melanoma is most commonly found in middle-aged and older caucasian patients. One-third of all uveal melanoma cases present asymptomatically. Early diagnosis facilitates treatment before ocular melanoma reaches metastatic stage IV. Current therapy options for stage IV patients are palliative care and clinical trial participation.LEARNING POINTSMasquerade syndrome and intraocular haemorrhage can hide a neoplastic aetiology.A biopsy should be carried out for correct diagnosis if intraocular haemorrhage is present and a neoplastic pathology is suspected.A multidisciplinary approach should be adopted to enhance the quality of life of patients with metastatic ocular melanoma.

Интравитреальные инъекции в ветеринарной офтальмологии: обзор литературы

The treatment of pathologies of posterior segment of eye, such as chorioretinitis, uveitis, various neuroretinopathies, vitreous diseases, intraocular hemorrhage, is a rather serious problem due to the difficulties of the adequate delivery of preparations into area of pathological process. One of the most effective ways to deliver drugs to eye tissue in posterior segment are intravitreal injections. The introduction of drugs is carried out directly into vitreous body through a puncture of sclera. This article presents the indications for intravitreal injections, a detailed description of properties of numerous therapeutic agents that can be delivered through intravitreal injections, potential complications of this technique and recommendations for prevention of side effects.

Surgical management of intraocular lens dislocation: A meta-analysis.

PurposeTo compare the efficacy and safety of intraocular lens (IOL) repositioning and IOL exchange for the treatment of patients with IOL dislocation.MethodsWe systematically searched for relevant publications in English or Chinese in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registration Platform, Clinical Trial.gov, China Biology Medicine Database, China National Knowledge Infrastructure Database and grey literature sources. Study quality was assessed using the STROBE template for observational studies and the Cochrane template for randomized controlled trials (RCTs). Data were meta-analyzed using RevMan 5.3.ResultsThe review included 14 English-language studies reporting 1 RCT and 13 retrospective case series involving 1,082 eyes. Average follow-up time was 13.7 months. Pooled analysis of 10 studies showed that the two procedures had a similarly effect on best corrected visual acuity (MD -0.00, 95%CI: -0.08 to 0.08, P = 0.99). Pooled analysis of nine studies showed no significant difference in incidence of IOL redislocation (RR 2.12, 95%CI 0.85 to 5.30, P = 0.11); pooled analysis of seven studies showed greater extent of incidence of cystoid macular edema in IOL exchange (RR 0.47, 95%CI 0.21 to 1.30, P = 0.06). Pooled analysis of three studies showed greater extent of incidence of anterior vitrectomy in IOL exchange (RR 0.11, 95%CI 0.04 to 0.33, P<0.0001). Pooled analysis of two studies showed greater postoperative spherical equivalents in IOL repositioning (MD 1.02, 95%CI 0.51 to 1.52, P<0.0001). pooled analysis suggested no significant differences between the two procedures in terms of intraocular pressure, endothelial cell density, surgically induced astigmatism, or incidence of retinal detachment, intraocular hemorrhage or pupillary block.ConclusionIOL repositioning and exchange are safe and effective procedures for treating IOL dislocation. Neither procedure significantly affects best corrected visual acuity and IOL redislocation. IOL exchange was superior to repositioning in terms of postoperative SE, but IOL repositioning was associated with lower incidence of anterior vitrectomy, potentially lower incidence of cystoid macular edema.

Intracameral Phenylephrine to Arrest Intraoperative Intraocular Bleeding: A New Technique.

Intraoperative intraocular bleeding can present a major challenge during anterior segment operations, such as cataract and glaucoma surgery. In the presence of significant intraocular bleeding, the surgeon may be unable to proceed if the bleeding cannot be controlled. Uncontrolled bleeding may also result in intraoperative or postoperative complications. Intracameral injection of phenylephrine was used in three consecutive cases of intraoperative anterior chamber bleeding during cataract surgery, one of which was combined with CyPass® Micro-Stent insertion. This resulted in complete cessation of bleeding within a minute of the injection. No further intraoperative or postoperative hemorrhage was seen. As far as we know, this is the first report of intracameral phenylephrine use intraoperatively to successfully stop anterior chamber bleeding, enabling safe completion of surgery.Electronic supplementary materialThe online version of this article (10.1007/s40123-019-0165-y) contains supplementary material, which is available to authorized users.

Intravitreal dexamethasone implants versus intravitreal anti-VEGF treatment in treating patients with retinal vein occlusion: a meta-analysis

BackgroundRetinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO.MethodsThe PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment.ResultsFour randomised controlled trials assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = − 10.59, P < 0.00001) and more CST decrease (MD = − 86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema.ConclusionsAnti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients.

Ocular emergencies: what every radiologist should know

Purpose/Aim 1. Make a review of the most important ophthalmic emergencies, including some severe ophthalmologic diseases and life threatening systemic conditions; 2.Describe the main ultrasound, CT and MRI findings of these disorders. 3. Emphasize the imaging aspects that should be reported by radiologists, essentials to early treatment. Content Organization 1. The ophthalmic presentations listed herein are very common in the primary care setting. 2. We grouped these emergencies as follows: traumatic (open globe, orbital fractures and intraocular foreign bodies), infectious (pre-septal and post-septal celullitis, endophthalmitis, abscess), intraocular hemorrhage (vitreous hemorrhage), vascular occlusions (retinal vein occlusion, central retinal artery occlusion), detachments (retinal, posterior vitreous, choroidal), CNS pathologies (Terson's syndrome, strokes, tumors, aneurysms, demyelinating diseases) and systemic conditions (giant cell arteritis, cavernous sinus thrombosis, Horner's syndrome) 3. Radiologists should be able to recognize and precisely report the major imaging aspects of each condition, working along with specialists and clinicians on their prompt management, to avoid either ophthalmic or systemic morbidity. Summary Many ophthalmic emergencies may present with vague initial symptoms or be associated to systemic conditions. In such cases, most of general doctors may require complementary exams, making the accurate radiologic diagnosis essential to early treatment. Radiologists must be alert to ocular anatomy in every head and neck study, notably when clinical complaint is related to vision, in CNS and sinuses pathologies and in the context of trauma, inflammatory or infectious diseases. That's the way we can make the difference helping to preserve these patient's visual function or, even, in their lives.

Unusual Severe Intraocular Hemorrhage Following Glaucoma Surgery in Patients with Systemic Lupus Erythematous

Unusual Severe Intraocular Hemorrhage Following Glaucoma Surgery in Patients with Systemic Lupus Erythematous

Intrusion of Dacron suture knot 15\u2009years after scleral buckling

BackgroundWe present a case of intrusion of a suture knot 15 years after scleral buckling surgery.Case presentationA 62-year-old woman with high myopia had undergone scleral buckling surgery in her left eye 15 years previously for rhegmatogenous retinal detachment. She recently displayed highly elevated intraocular pressure, with hyphema and vitreous hemorrhage. After the blood was cleared, a ring-shaped protrusion was noted around the equator of the eyeball, with a blue suture knot standing out on its surface and extending into the vitreous cavity at 5 o’clock. The suture knot was removed successfully. Mass spectrometry revealed that the material of the suture was polyethylene terephthalate, or Dacron. One week later, at the place where the suture knot had been located, the choroidal and retinal tissue disappeared and the silicone buckle remained an uncovered intrusion, whereas the rest of the retina was still attached.ConclusionsThe suture knot was possibly the one used to close the drainage port for subretinal fluid, which was covered by the encircling band. During the buckling procedure, covering a nonabsorbable suture, which is usually placed where the sclera is compromised by trauma or the surgical incision, with an encircling band may lead to the intrusion of the suture. Therefore, a soft absorbable suture may be preferable, if possible.

Early Retinal Findings Following Cooling in Neonatal Encephalopathy.

Perinatal HI (hypoxia-ischemia)-related visual defects including blindness are known to be associated with ischemic lesions in intracerebral visual pathways and ischemic retinal damage (IRD). Intraocular hemorrhages (IOH) such as retinal hemorrhage (RH), which may result from perinatal HI, can cause IRD by various mechanisms. We aimed to evaluate the early retinal findings in neonates with moderate-to-severe neonatal encephalopathy (NE) who underwent TH and its relationship between coagulation status, amplitude-integrated electroencephalography (aEEG) patterns, and magnetic resonance imaging-magnetic resonance spectroscopy (MRI-MRS) findings. A total of 31 newborn infants who underwent moderate-to-severe NE and TH included in the study. Coagulation parameters were taken immediately before starting TH, and daily during TH period. aEEG records were obtained during TH and rewarming period.Binocular indirect ophthalmoscopic examination (BIOE) and MRI-MRS scanning were performed when TH protocol completed. Total 13 (41.9%) patients had abnormal BIOE findings. Ten of them were (77%) IOH, other findings are as follows: RH (n = 7), optic disc hemorrhage (n = 2), and vitreous hemorrhage (n = 1). Initial coagulation status was not related to IOH. Worsened aEEG and MRI-MRS results were not related to BIOE findings. Frequency of IOH is high in newborns with NE who underwent TH being independent from severity of MRS-MRI findings, aEEG pattern, and disturbed coagulation status.

Intraocular bleeding in patients managed with novel oral anticoagulation and traditional anticoagulation: a network meta-analysis and systematic review

Background/aimTo clarify the nature of the relationship between novel oral anticoagulants (NOACs) and traditional anticoagulation in respect to intraocular bleeding.MethodsA comprehensive literature search up to October 2017 yielded 12 randomised...

Comparison of Three Intraocular Lens Implantation Procedures for Aphakic Eyes With Insufficient Capsular Support: A Network Meta-analysis

To compare the clinical outcomes and main complications of transscleral-fixated (TSF), intrascleral-fixated (ISF), and iris-fixated (IF) intraocular lenses (IOLs). Systematic review and network meta-analysis. The authors searched PubMed, EMBASE, and the Cochrane Library for relevant articles up to April 2017 with no language restrictions, and related studies meeting the eligibility criteria were included. A Bayesian framework was applied to compare the visual outcomes and complications of these 3 approaches. A total of 14 studies with 845 eyes were included in the present report. There was no significant difference between any pair of surgical approaches in best-corrected visual acuity (BCVA) and in final BCVA achieving 20/40 or better (Snellen). ISF presented a lower risk of cystoid macular edema (CME) compared with TSF (risk ratio [RR], 0.45; 95% confidence interval [CI], [0.18, 1.0]). IF showed superiorities in less intraocular hemorrhage (IOH) than ISF (RR, 0.078; 95% CI [0.0095, 0.38]), as well as TSF (RR, 0.26; 95% CI, [0.09, 0.72]). IF had a lower risk of glaucoma escalation; the difference was slightly higher than the conventional level of significance (RR, 0.41; 95% CI, [0.16, 1.04]). Moreover, the surgical time in IF was shorter than TSF (standard mean difference [SMD], -2.98; 95% CI, [-4.32, -1.64]) and ISF (SMD, -2.60; 95% CI, [-3.71, -1.49]). However, IF was associated with a significantly higher risk of endothelial cell density (ECD) impairment (SMD, -0.54; 95% CI, [-1.02, -0.05]) and significantly greater postoperative corneal endothelial cell loss rate (ECLR, %) (SMD, 0.35; 95% CI, [0.08, 0.63]) compared with TSF. Postoperative visual outcomes were comparable among TSF, ISF, and IF for eyes with insufficient capsular support. However, the risk of some complications differed among approaches. IF showed its superiorities in lower risk of IOH and glaucoma escalation as well as shorter surgical time, while IF was at a disadvantage in greater endothelial cell impairment. Since some patients might have a clear contraindication to one of the surgical approaches, the decision of surgical approach eventually depends on surgeon experience and the presenting pathology.

Transscleral tunnel incision related arterial hemorrhage in 23-gauge Vitrectomy: case report

BackgroundTransscleral tunnel incisions are commonly made to avoid postoperative leakage in small gauge sutureless vitrectomy. We present an unreported intraoperative complication, tunnel incision related arterial hemorrhage from sclerotomy, in 23-gauge (23G) vitrectomy.Case presentationTwo cases of intraocular arterial hemorrhage from superonasal sclerotomy were observed at the beginning of vitrectomy. The bleeding filled the vitreous cavity quickly and gushed out from the incision port after the involved supronasal cannula was removed. The active bleeding seemed not to stop spontaneously. We controlled the active bleeding by relocating the involved cannula, elevating the intraocular pressure and compressing the sclera wound. Post-operative intraocular hemorrhage from the sclerotomy was not found in any of the two cases.ConclusionsWe suggest that the bleeding was from injured ciliary artery when the incision crossed 3 or 9 o’clock accidently. Surgeons might avoid this complication by locating the superior incisions away from the horizontal axis, and should be aware the proper management.

Fibrovascular proliferation of retinopathy of prematurity in zone II after initial ranibizumab treatment

This study was designed to explore the prevalence of fibrovascular proliferation not regressed in zone II stage 3 retinopathy of prematurity (ROP) after initial intravitreal ranibizumab (IVR) injections and to explore the possible influence factors. Fifty-seven patients (108 eyes) with ROP who underwent intravitreal injection of ranibizumab between January 2013 and July 2014 participated in the retrospective study. Based on regress of fibrovascular tissue or not after initial injections of ranibizumab, eligible eyes were divided into two groups. Data was collected and analyzed with SPSS 16.0. In the study, 108 eyes of 57 patients (18 females, 39 males) underwent initial intravitreal injection. The mean birth weight was 1,440.0±357.7 g and the mean gestational age was 30.5±2.0 weeks. Eight of 57 (14.0%) patients showed unfavorable fibrovascular proliferation after initial ranibizumab treatment within 2 weeks. Among them, 11 eyes were controlled by further laser treatment and 3 eyes underwent vitrectomy. The difference of occurrence rate in hemorrhage between the two groups was significant (P<0.030), and the unfavorable group required more laser treatment (P<0.001). The incidence of unfavorable fibrovascular proliferation was relatively high, and intraocular hemorrhage was possibly associated with the progress in zone II stage 3 ROP after initial IVR injection.

Ahmed Glaucoma Valve Implantation in Vitrectomized Eyes.

Purpose To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes. Materials and Methods The medical records of 13 eyes that developed glaucoma due to emulsified silicon oil or neovascularization following pars plana vitrectomy and underwent AGV implantation were retrospectively reviewed. The main outcome measures were intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of antiglaucoma medications, and postoperative complications. Surgical success was defined as last IOP ≤21 mmHg or ≥6 mmHg and without loss of light perception. Results The mean follow-up duration was 11.7 ± 5.5 (range, 6–23) months. The mean IOP before the AGV implantation was 37.9 ± 6.7 mmHg with an average of 3.5 ± 1.2 drugs. At the final visit, the mean IOP was 15.9 ± 4.6 mmHg (p=0.001) and the mean number of glaucoma medications decreased to 2.3 ± 1.3 (p=0.021). At the last visit, 11 eyes (84.4%) had stable or improved VA and one eye (7.7%) had a final VA of no light perception. Surgical success was achieved in 11 of the 13 eyes (84.4%). Postoperative complications were bleb encapsulation (69.2%), early hypotony (38.5%), hyphema (23.1%), decompression retinopathy (23.1%), choroidal detachment (15.4%), intraocular hemorrhage (7.7%), and late endophthalmitis (7.7%). One eye (7.7%) was enucleated because of late endophthalmitis. Conclusions Despite complications necessitating medical and surgical interventions, vitrectomized eyes were effectively managed with AGV implantation.

A case of sudden-onset painless unilateral vision loss postintravenous streptokinase in a patient of acute inferior-wall myocardial infarction

Coronary thrombolysis with intravenous (IV) streptokinase is widely used as a strategy for coronary reperfusion for acute myocardial infarction (MI). Systemic administration of fibrinolytic agents is associated with hemorrhagic risks such as cerebral hemorrhage, gastrointestinal bleeding, cardiogenic shock, and unusual complications such as splenic rupture, aortic dissection, and cholesterol embolization. Herein, we report a case of intraocular hemorrhage 1 day after the IV administration of streptokinase for acute inferior-wall MI.

BILATERAL INTRAOCULAR HEMORRHAGE SECONDARY TO CEREBRAL VENOUS SINUS THROMBOSIS

To report a case of bilateral intraocular hemorrhage secondary to cerebral venous sinus thrombosis with no associated intracranial hemorrhage. Case report. A 32-year-old Asian gentleman presented with left reduced vision as a result of a left subhyaloid macular hemorrhage associated with severe headache. Right retinal hemorrhages were also present. Magnetic resonance imaging and computed tomography brain imaging demonstrated cerebral transverse venous sinus thrombosis. Intraocular hemorrhage has previously been described in association with intracranial hemorrhage and in particular subarachnoid hemorrhage (Terson syndrome). We describe a similar clinical picture in the context of cerebral venous sinus thrombosis with no associated intracranial hemorrhage.

Association of Novel Oral Antithrombotics With the Risk of Intraocular Bleeding

ImportanceNovel oral anticoagulation and antiplatelet therapies have become a mainstay of treatment for thromboembolic disease. However, the safety profile of these medications has not been completely characterized.ObjectiveTo determine the risk of developing intraocular hemorrhages with novel oral antithrombotic therapy compared with that of traditional antithrombotic agents.Design, Setting, and ParticipantsIn this retrospective cohort study, a large national insurance claims database was used to generate 2 parallel analyses. All patients with incident use of dabigatran etexilate or rivaroxaban between January 1, 2010, and September 30, 2015, were compared with patients with incident use of warfarin sodium. Similarly, patients with new use of prasugrel hydrochloride were compared with those with new use of clopidogrel bisulfate. Both analyses required the patient to be in the insurance plan for at least 24 months prior to initiation of therapy and excluded patients with any previous diagnosis of intraocular hemorrhages or any prescription for the comparator medications. Furthermore, the antiplatelet analysis required a diagnosis of acute coronary syndrome or a myocardial infarction within 60 days of initiation of pharmacologic therapy. The anticoagulant analysis excluded patients with end-stage renal disease, renal transplants, and those with heart valve disease.Main Outcomes and MeasuresIncident intraocular hemorrhages at 90 and 365 days. Multivariate Cox proportional hazards regression models were used to compare the hazard ratio (HR) of developing an intraocular hemorrhage in individuals taking novel agents compared with those taking traditional medications.ResultsA total of 146 137 patients taking warfarin (76 714 women and 69 423 men; mean [SD] age, 69.8 [11.8] years) were compared with 64 291 patients taking dabigatran or rivaroxaban (31 576 women and 32 715 men; mean [SD] age, 67.6 [11.7] years). Cox proportional hazards regression revealed a decreased hazard for developing an intraocular hemorrhage with dabigatran or rivaroxaban at 365 days (HR, 0.75; 95% CI, 0.58-0.97; P = .03), but not at 90 days (HR, 0.73; 95% CI, 0.22-2.63; P = .13). A total of 103 796 patients taking clopidogrel (37 578 women and 66 218 men; mean [SD] age, 68.0 [11.3] years) were compared with 8386 patients taking prasugrel (1988 women and 6380 men; mean [SD] age, 61.0 [9.6] years) and no increased hazard for developing an intraocular hemorrhage with prasugrel was seen at 90 days (HR, 0.75; 95% CI, 0.29-1.92; P = .55) or 365 days (HR, 1.19; 95% CI, 0.69-2.04; P = .53).Conclusions and RelevanceThese results suggest a decreased risk of intraocular hemorrhage associated with novel direct thrombin inhibitors and direct factor Xa inhibitors, but no difference for P2Y12 inhibitors compared with traditional vitamin K anticoagulation and antiplatelet therapy, respectively.

Efficacy and safety of the pars plana clip in the Ahmed valve device in patients with refractory glaucoma

PurposeTo evaluate the efficacy and safety of the pars plana clip (PPC) in the Ahmed valve tube PC7 inserted via the pars plana in patients with secondary refractory glaucoma.MethodsProspective and interventional case series that included 8 patients with secondary refractory glaucoma. The pars plana vitrectomy and the implant of the modified tube were performed during the same surgery. Control of intraocular pressure (IOP) and the development of intra‐ and postoperative complications were evaluated during the follow‐up.ResultsFollow‐up time was twelve months in all the patients. Control of IOP was achieved in 85% of patients, and 75% needed no antiglaucoma treatment. The complications that occurred were transient hypotony in two cases, choroidal detachment in two cases, and one case of intraocular hemorrhage and one case of hyphema. No case of tube extrusion was observed.ConclusionsOur clinical experince suggests that implantation of the Ahmed tube modified with the PPC via the pars plana is safe and effective in patients with secondary refractory glaucomas.