Persistent Vitreous Hemorrhage Research Articles

Combined preoperative and intraoperative aflibercept injection versus preoperative intravitreal aflibercept injection only in optimizing the anatomical and functional outcomes in diabetic vitrectomy

Purpose The aim of this study was to evaluate the effect of adding intraoperative aflibercept injection to preoperative injection in optimizing the anatomical and functional outcomes of diabetic vitrectomy compared to preoperative injection only. Patients and methods This retrospective interventional comparative study included 30 eyes of 30 patients scheduled for pars plana vitrectomy for complications of proliferative diabetic retinopathy. The patients were allocated into two groups: group I that received combined preoperative and intraoperative aflibercept (Eylea) injection and group II that received preoperative injection only. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared preoperatively and 3 months postoperatively in both groups. The patients were also followed up to detect any postoperative persistent vitreous hemorrhage (VH) or sub-silicone hemorrhage. The patients who developed persistent nonclearing VH for more than 1 month or persistent nonclearing sub-silicone premacular hemorrhage were scheduled for surgical reintervention. Results The mean preoperative BCVA was 1.53±0.28 LogMAR in group I and 1.50±0.26 LogMAR in group II. At the end of the third postoperative month, there was a continuous significant improvement in BCVA in both groups with a mean of 0.31±0.10 in group I and 0.62±0.26 in group II, with a statistically significant difference between the two groups (P<0.0001). The baseline CMT was measured within 1–3 weeks postoperatively with a mean of 393±31.54 μm in group I and 379.3±40.42 μm in group II. Three months postoperatively, the CMT significantly decreased to 206±12.94 μm in group I and 301.67±48.6 μm in group II with a statistically significant difference between the two groups (P<0.0001). Postoperative persistent VH occurred in three eyes out of the six (50%) air-filled eyes in each group, while three eyes out of the eight (37.5%) silicone-filled eyes in group I and six (60%) eyes out of the 10 silicone-filled eyes in group II developed postoperative sub-silicone hemorrhage. Only one (12.5%) case in group I and five cases in group II required surgical reintervention due to persistent sub-silicone hemorrhage. Conclusion Combined preoperative and intraoperative aflibercept injection compared to preoperative injection alone was more effective in optimizing the anatomical and functional outcomes and in reducing the possible postoperative complications after pars plana vitrectomy.

Outcomes, efficacy and risk factors of 27-Gauge vitrectomy for diabetic tractional retinal detachment in Japanese patients.

Diabetic retinopathy leads to vision-threatening complications, such as proliferative diabetic retinopathy and tractional retinal detachment (TRD) and is a major global health concern. Despite advancements in vitrectomy techniques, challenges exist in managing postoperative complications and long-term visual acuity. This study aimed to evaluate postoperative outcomes of 27-gauge pars plana vitrectomy (27g PPV) for diabetic TRD and identify associated risk factors. Retrospective study. This study included 94 eyes of 74 patients who underwent 27g PPV for diabetic TRD between July 2017 and September 2022 at Juntendo University Urayasu Hospital, Japan. Patient demographics, preoperative characteristics, intraoperative details, and postoperative outcomes were examined. Statistical analyses were performed to identify factors influencing postoperative visual acuity. Mean follow-up duration was 23.1 ± 14.6 months. Postoperatively, visual acuity (LogMAR) improved significantly from 1.34 ± 0.82 to 0.65 ± 0.79 (P < 0.0001). Postoperative complications included persistent vitreous hemorrhage (15%) and neovascular glaucoma (4%). Final retinal reattachment rate was 97%. Preoperatively, macular detachment (P < 0.0001) and Grade IV TRD (P < 0.0001) severity were significantly associated with poor final best corrected visual acuity (P < 0.0001). Preoperative macular detachment (P < 0.0001), Grade IV TRD (P < 0.0001), intraoperative iatrogenic breaks (P = 0.031), and postoperative neovascular glaucoma (P < 0.0001) were identified as significant predictors of poor postoperative visual outcomes through multivariate analysis. This study highlights the efficacy of 27g PPV in improving visual acuity in patients with diabetic TRD. Despite favorable outcomes, attention to preoperative risk factors and meticulous surgical techniques remain crucial for optimizing long-term visual prognosis in these patients.

Clinical Characteristics of Proliferative Diabetic Retinopathy and Outcome of Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy.

Proliferative diabetic retinopathy is a leading cause of blindness among people with diabetes. The study aimed to assess the clinical characteristics of proliferative diabetic retinopathy and outcome of pars plana vitrectomy in Proliferative diabetic retinopathy. A prospective study was conducted from September 2019 to December 2021 among consecutive cases of proliferative diabetic retinopathy who underwent pars plana vitrectomy at a tertiary eye care center. Study was conducted after ethical approval from Institutional Review Committee. Detailed systemic and ocular history, visual acuity, ocular findings under mydriasis, surgical procedures, and outcome following pars plana vitrectomy were recorded. Cases were followed up regularly until one year after the pars plana vitrectomy. Total of 83 cases (89 eyes) of proliferative diabetic retinopathy were enrolled in the study. The mean age was 53 years ±9.7 SD, ranging from 26 years to 72 years. Males comprised of 62.7% cases. Type two diabetes comprised of 94% of cases. Indications for pars plana vitrectomy were; mixed vitreous hemorrhage and tractional retinal detachment (38.2%), non-clearing vitreous hemorrhage (38.1%), and tractional retinal detachment only (24.7%). Pre-operative intra-vitreal anti-vascular endothelial growth factor was given in 78.65% eyes and pan retinal photocoagulation in 58.42% eyes. The anatomical success was achieved in 95.5% eyes, visual improvement in 68.54%, static in 14.6% and worsened in 16.86% of eyes. About 15.7% of eyes had some form of post- operative complications. Vitreous hemorrhage with tractional retinal detachment, persistent vitreous hemorrhage and tractional retinal detachment involving macula were the common indication of pars plana vitrectomy among cases of Proliferative diabetic retinopathy. Anatomical success and visual acuity improvement can be achieved in majority of the eyes following PPV in Proliferative diabetic retinopathy.

Characteristics of Spontaneously Regressed Retinopathy of Prematurity at Termination of Acute Retinal Screening Examinations Using a Novel Grading System.

To characterize and compare residual retinal changes of spontaneously regressing retinopathy of prematurity (ROP) at termination of acute-phase retinal screening examinations. A retrospective chart review of 521 infants screened for ROP from 2016 to 2019 was performed. Data were collected on patients with at least stage 1 ROP, but who were not treated. The primary outcome measure was presence of residual fibrotic retinal tissue at termination of acute ROP screening examinations. Secondary outcomes included: type of residual fibrotic retinal tissue, persistent avascular retina, vitreous hemorrhage, and retinal detachment. A novel grading system was used to categorize findings. Comparisons between groups were made using Fisher exact tests. A total of 255 eyes met inclusion criteria. A total of 206 of 255 eyes (81%) showed persistent avascular retina, whereas 57 of 255 eyes (22%) showed residual fibrotic retinal tissue at termination of acute screening. All eyes with previous stage 3 ROP showed residual fibrotic retinal tissue (8 of 8 eyes, 100%). Eyes whose highest stage of ROP was stage 2 showed more residual fibrotic retinal tissue at termination of acute screening (40 of 73 eyes, 55%) compared to eyes whose highest stage was stage 1 (9 of 174, 5%) (P < .0001). Stage 3 eyes were excluded from this comparison due to the small sample size. One eye had vitreous hemorrhage at post-menstrual age 44 1/7 weeks. No eyes had retinal detachment. Despite meeting at least one of the criteria for termination of acute ROP screening, residual fibrotic retinal tissue and persistent avascular retina are common after spontaneous regression of ROP. Further investigation into the long-term clinical significance of these residual changes is warranted. [J Pediatr Ophthalmol Strabismus. 2023;60(5):359-364.].

CLINICAL CHARACTERISTICS OF EALES DISEASE AND THE EFFICACY OF DIFFERENT INTERVENTIONS FOR NEOVASCULAR COMPLICATIONS.

To evaluate clinical features and manifestations of Eales disease and the efficacy of different interventions. The databases PubMed, EMBASE, and Ovid from inception until February 2021 were searched. Pooled analyses included 1) presenting features, 2) symptoms and signs, and 3) postoperative vision outcomes and complications. Statistical analyses were conducted with R software version 3.6.3. Forty-seven studies involving 3,557 patients and 4,959 eyes were included. The pooling results showed that Eales disease was male dominated (94%), bilateral involvement (64%), and mainly occurred in adolescents. Approximately 83% of patients were positive in Mantoux test, and 31% of patients have vitreous tap polymerase chain reaction positive for tuberculosis genome. More than half of the patients had decreased vision at the first clinic visit. The common signs of Eales disease included sclerotic vessels (83%), neovascularization of retina elsewhere (64%) and periphlebitis (51%). Macular changes could be detected in 24% of patients. The most common complication was vitreous hemorrhage, followed by cataracts and retinal detachment. Photocoagulation was directed at nonperfusion or neovascularization areas, with a decrease in the incidence of later pars plana vitrectomy (19%). Anti-vascular endothelial growth factor treatment was suggested for vitreous hemorrhage, which could achieve high visual acuity improvement rate (82%) while increasing the possibility of retinal detachment (18%). Pars plana vitrectomy was indicated in cases with persistent vitreous hemorrhage or retinal detachment, with 56% of patients obtaining visual improvement. Still, 17% of patients needed a second pars plana vitrectomy, mainly because of recurrent vitreous hemorrhage or retinal detachment. Eales disease most commonly affects young men. It has diverse clinical features, and management should be based on the progression of the disease.

Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma.

Précis:Irrigating goniectomy with the TrabEx+ device can lower intraocular pressure (IOP) in patients with glaucoma, as a standalone procedure or combined with cataract surgery.Purpose:The aim was to describe the efficacy and safety of irrigating goniectomy performed using the TrabEx+ device, either as a standalone procedure or combined with cataract surgery, in eyes with medically treated open-angle glaucoma.Methods:A retrospective case series of eyes treated by a single surgeon at a single UK teaching hospital. Data was collected at follow-up visits at 1 week, 3, 6, 12, 18, and 24 months postoperatively. Primary outcomes included IOP and glaucoma medication reduction after surgery. Proportion of eyes achieving >20% IOP reduction, IOP <21 mm Hg, and no reoperation were classified as surgical success.Results:Seventy-three consecutive eyes of 64 patients (mean age 68.4±13.7 y) were enrolled. 62% were treated as combined procedures with cataract surgery. Overall, mean IOP decreased from 31.3±7.3 to 20.9±10.4 mm Hg at the latest follow-up (34% reduction) (P<0.001) at the latest follow-up (16.1±10.3 mo) with mean preoperative medications decreased from 2.9±1.2 to 1.9±1.3 (P<0.001). 73% met the definition of success at latest follow-up. Postoperative complications were recorded including hyphaema (17%), uveitis (3%), hypotony (1%), and persistent vitreous hemorrhage (1%). Eighteen percent required reoperation because of treatment failure.Conclusion:TrabEx+ appears to be effective in lowering IOP and medication with or without cataract surgery. However, long-term safety and efficacy will be better understood in a prospective study with longer follow-up.

Early vitrectomy in eyes with non-diabetic vitreous hemorrhage.

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 (p = 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 (p = 0.447). When comparing initial and final BCVAs, the difference was significant only in the early PPV group (p = 0.00001) and was not significant in the conservative group (p = 0.066) and in the late PPV group (p = 0.46). Complications included RRD (n = 2) and re-bleed in vitrectomized cavity (n = 1) in the early surgical group, need for additional laser or cryoretinopexy to RTs (n = 2), retinal detachment (n = 1), neovascular glaucoma (n = 1), persistent vitreous hemorrhage (n = 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.

A case of air pollution-induced Valsalva retinopathy

This is a case of Valsalva retinopathy during the season of annual transboundary haze pollution in Sarawak. A 22-year-old man with no known medical illness developed sudden onset of painless visual acuity loss preceded by persistent cough. Left eye fundus showed dense preretinal haemorrhage covering optic disc extendinginferiorly with breakthrough vitreous haemorrhage. The patient underwent pars plana vitrectomy, endolaser, and fluid gas exchange in view of persistent dense vitreous haemorrhage after a month of conservative management. In conclusion, pars plana vitrectomy can be considered as a safe and effective treatment option for patients with Valsalva retinopathy developing extensive premacular haemorrhage.

A Case of Recurrent Vasculitic Vitreous Haemorrhage in One Eye and Idiopathic Choroidal Granulomas in The Fellow Eye of A Young Individual

A 26-year-old male presented with sudden diminution of vision in right eye (OD) for 15 days. Best-corrected visual acuity (BCVA) was finger counting 1-metre in OD and 6/6 in left eye (OS). Fundus examination revealed fresh vitreous haemorrhage (VH) in OD. Investigations including complete haemogram, VDRL, Mantoux test and Contrast-Enhanced Computed Tomography chest were normal. A presumptive diagnosis of Eales disease was made. Subsequently he also developed multiple small choroidal granulomas in OS. He was started on oral corticosteroid and treated with multiple episodes of scatter-laser and intravitreal bevacizumab in OD for recurrent VH. He ultimately required pars-plana vitrectomy in OD for persistent VH despite anti-VEGF and laser. Choroidal granulomas in OS disappeared after treatment with oral steroid. He maintained BCVA of 6/6 in both eyes after 6-months and was kept under close follow-up. Multimodal approach and combination modality of treatment may be required for optimal outcome in such cases.

VISUAL OUTCOME, CLINICAL FINDINGS AND MANAGEMENT OF BLUNT OCULAR TRAUMA DUE TO SHOTGUN PELLETS.

Purpose: To analyze the clinical ndings, management and visual prognosis of blunt ocular injuries due to shotgun pellets. Methods: A prospective observational study on 200 eyes with blunt ocular trauma due to shotgun pellets was conducted. Patients with other causes of ocular trauma or with open globe injury were excluded from study. Surgical interventions were employed when indicated for associations like, traumatic cataract, dense persistent vitreous hemorrhage(VH),retinal detachment(RD) etc. Patients were followed up for 6 months from time of injury. Results: The mean age of patients was 22.6+9.52 years. Majority (99.5%) of our patients were males and only 1(0.50%) was female. Subconjunctival hemorrhage (SCH) was the most common clinical manifestation(77.0%) followed hyphaema in 34.0% of patients and vitreous hemorrhage(VH) (27.5%). Cataractous changes were seen in 7.5% of patients, retinal hemorrhage in 11.0% while retinal detachment(RD) in 4.0%. 60.5% of patients were managed conservatively and 39.5% patients needed surgical intervention. Visual Acuity(VA) at presentation was recorded to be &lt;6/60-PL(light perception) in 51.0% of the patients which progressed to range of 6/6 -6/9 in 82.5% of patients. 2 patients reported with no perception of light (NPL) at the time of trauma which persisted till the end of follow-up. Conclusion: We conclude that the blunt ocular trauma due to pellets occurs most commonly in males, and has a good prognosis in terms of anatomical and functional outcome. Anterior segment was more commonly involved than the posterior segment with reparable damage in majority of the cases. Educating the mass for use of any form of eye protection can prevent ocular trauma in most cases

Combined intra-arterial chemotherapy and intravitreal melphalan for the treatment of advanced unilateral retinoblastoma.

To evaluate the efficacy and safety of combined intra-arterial chemotherapy (IAC) and intravitreal melphalan (IVM) for the treatment of advanced unilateral retinoblastoma. This retrospective study involved 30 consecutive eyes from 30 Chinese patients with advanced unilateral retinoblastoma. All patients were initially treated with IAC combined with IVM. The clinical status and complications were recorded at each visit. The International Intraocular Retinoblastoma Classification groups were D in 23 eyes and E in 7 eyes. All eyes showed severe cloud vitreous seeds at the first visit. The mean number of IAC cycles and intravitreal injections was 3.2 (range, 3-4) and 6 (range, 1-14), respectively. The median follow-up time was 29mo (range, 7-36mo). Treatment success with regression of the retinal tumor and vitreous seeds was achieved in 29 of 30 eyes (96.7%). Globe salvage was attained in 93.3% (28/30) eyes, and enucleation (n=2) was performed due to neovascular glaucoma and persistent vitreous hemorrhage. Complications included retinal pigment epithelium (RPE) atrophy (n=13; 43%), mild lens opacity (n=7; 23%), vitreous hemorrhage (n=5; 17%) and rhegmatogenous retinal detachment (n=1; 3%). No extraocular tumor extension or metastasis occurred. Combined IAC and IVM is effective and safe for the treatment of advanced unilateral retinoblastoma.

Intravitreal ranibizumab for persistent diabetic vitreous haemorrhage: a randomised, double-masked, placebo-controlled feasibility study.

To determine the feasibility of a definitive study of intravitreal ranibizumab to promote the clearance of persistent diabetic vitreous haemorrhage and thereby avoid vitrectomy. This randomised, double-masked, placebo-controlled feasibility study recruited24 participants with persistent diabetic vitreous haemorrhage listed for pars plana vitrectomy.Participants were randomised to a single 0.5-mg intravitreal ranibizumab injection or a single subconjunctival saline injection.The primary outcome measure was thenumber of participants requiring pars plana vitrectomy at week 7. Eight of 12 participants (66.7%) in the ranibizumab group required vitrectomy at week 7 versus 12 of 12 (100%) in the placebo group (absolute risk reduction 33.3%, 95% confidence interval 2.1-70.7%;p=0.09). One additional eye in the ranibizumab group required vitrectomy by 12months. Mean visual acuity letter score at 12months was 72.7±12.3 in the ranibizumab group and 75.1±10.1 in the placebo group. Safety was similar across groups. Intravitreal ranibizumab may reduce the likelihood of proceeding to vitrectomy in patients with persistent, dense diabetic vitreous haemorrhage. Further studies appear feasible and justified.

Microscope-Assisted ab externo Surgery for the Treatment of Primary Rhegmatogenous Retinal Detachment – New Tech Meets Old Art

Aim: To report the outcomes of ab externo surgery using a surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted ab externo surgery) for rhegmatogenous retinal detachment (RRD). Methods: This was a retrospective study. Consecutive charts of patients with RRD who underwent microscope-assisted ab externo surgery were analyzed. The following demographic parameters were analyzed: age (years), gender (male/female), and eye (right/left). Clinical parameters were axial length (AL) measured in millimeters (mm), preoperative best-corrected visual acuity (BCVA) measured in logarithm of minimum angle of resolution (logMAR), intraocular pressure (IOP), and lens status (phakic/pseudophakic). The parameters of RRD were number and type of retinal breaks, location of retinal breaks, extent of retinal detachment (RD) (number of detached quadrants), and macular detachment (MD), as well as retinal breaks not detected preoperatively. Use of cryopexy, circumferential or segmental scleral buckle, drainage of subretinal fluid, injection of air or gas, and duration of surgery were recorded. The postoperative parameters analyzed were BCVA, IOP and recurrence of RD and postoperative complications. Follow-up was established at 3 months. Results: A total of 213 eyes (97 right, 116 left) of 205 patients (114 males, 91 females) affected by primary RRD were included. Fifty-two eyes (24.4%) were affected by high myopia (AL >26.5 mm), and 160 patients (75.1%) were affected by RRD caused by a single retinal break and involving only one quadrant. The superior quadrant was the most frequently involved (49.3%). Forty-two eyes (19.7%) were affected by MD. In 13 eyes (11.3%), retinal breaks were not detected preoperatively. The duration of surgery was 75.5 ± 42 min. No significant BCVA changes were observed in the whole group, whereas a significant improvement of BCVA from the baseline (2.83 ± 0.87 logMAR) to each time point of follow-up was observed in the subgroup of patients affected by MD. Six eyes (2.8%) developed a recurrent RD, secondary to proliferative vitreoretinopathy (3 eyes) and secondary to a new retinal break (3 eyes). Two eyes developed a persistent vitreous hemorrhage, and one eye developed a macular hole after 1 week. PPV was performed for both. Conclusion: Microscope-assisted ab externo surgery is effective and safe, it reduces discomfort, it allows the surgeon to work with both hands free, and provides an adequate visualization of each step being performed.

Characteristics and Outcomes of Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy Patients in a Limited Resource Tertiary Center over an Eight-Year Period.

Purpose To report characteristics and visual results in patients with PDR-associated complications following pars plana vitrectomy (PPV) in a tertiary center over an eight-year period. Methods Medical records of diabetic retinopathy patients receiving PPV between January 2007 and December 2014 for PDR-related complications were reviewed. Results A total of 890 consecutive PDR patients were included in the study. PPVs were performed for tractional retinal detachment (36.6%), persistent vitreous hemorrhage (VH) (35.4%), combined tractional and rhegmatogenous retinal detachment (14.5%), and vitreoretinal abnormalities (13.5%), respectively. Preoperative intravitreal bevacizumab injection (IVB) within two weeks prior to PPV and 23G vitrectomy systems was found to decrease the risk for intraoperative retinal break development (P=0.045 and P=0.015, respectively). The incidence of early dense postoperative VH decreased significantly with the administration of preoperative or intraoperative IVB at the end of PPV. Postoperative visual results significantly correlated with the initial visual acuity level, intraoperative retinal break development, and retained silicone oil tamponade at the final visit (P < 0.001, P=0.040, and P=0.044, respectively). Administration of adjuvant IVB either before or at the end of PPV had no significant association with the final visual outcomes. Conclusions This study reported an improvement in visual acuity in nearly half of patients receiving PPV for PDR-associated complications in a limited resource center. The incidence of intraoperative retinal break and early postoperative VH decreased significantly with the application of IVB injections. Poor final visual outcomes were related to the lower initial visual acuity levels, intraoperative retinal breaks, and postoperative retained silicone oil.

Terson syndrome with persistent vitreous hemorrhage following traumatic brain injury

The objective of this study was to report clinical findings and surgical outcomes of 3 patients with persistent vitreous hemorrhage diagnosed as Terson syndrome (TS). Posterior segment changes, optical coherence tomography scans, fundus autofluorescence images, and fundus fluorescein angiography findings of patients were evaluated and pars plana vitrectomy (PPV) was performed on 3 eyes of three patients. All eyes operated after 6 months from the date of injury and final visual acuities were 20/200, 20/60 and 20/30. PPV is found as a safe and effective procedure for vitreous hemorrhage in TS. Delayed surgery in a young patient predicts a worse outcome.

Universal ocular screening of 481 infants using wide-field digital imaging system

BackgroundUniversal ocular screening of infants is not a standard procedure in children’s health care system in China. This pilot study investigated prevalence of ocular abnormalities of 6 weeks-age infants using wide-field digital imaging system.MethodsInfants aged 6 weeks around were consecutively enrolled in a public hospital between April 2015 and August 2016. All the infants who were enrolled in the study underwent vision assessment, eye position examination, external eye check, pupillary light reflex, red reflex examination, anterior and posterior ocular segments were examined using flashlight, ophthalmoscope, and wide-field digital imaging system.ResultsA total of 481 infants at 45.1 ± 6.1 days after birth were enrolled in the study. 198 infants had abnormal findings (41.2%). Retinal white spots and retinal white areas were the most common findings (42.9% of abnormalities and 17.7% of all infants screened). The second major finding was retinal hemorrhage (16.2% of abnormalities and 6.7% of all infants screened). Other abnormal findings include retinal pigmentation, concomitant exotropia, neonatal dacryocystitis, retinopathy of prematurity, ‘albinism-like fundus’, congenital nasolacrimal duct obstruction, familial exudative vitreoretinopathy, immature retina, corneal dermoid tumor, large physiologic cupping of optic disc, congenital persistent pupillary membrane, entropion trichiasis, subconjunctival hemorrhage, congenital cataract, vitreous hemorrhage, ptosis and choroidal nevus. Intervention of any form was required in 22 infants, which accounted for 11.1% of abnormalities detected and 4.6% of all infants screened.ConclusionUniversal ocular screening is not only necessary for preterm infants but also for full-term infants. Addition of red reflex examination with wide-field digital imaging system can enhance the sensitivity of screening for ocular fundus abnormities. Further study with a long-term follow-up is needed in the future.

Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy

Aim: To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy as regarding safety and efficacy in pars plana vitrectomy. Patients and methods: A prospective non –randomized interventional study comparing the two vitrectomy systems in a group of disease requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL–Hayaha Eye Center (Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A) 23 –gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy (PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication, outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation (FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema or macular hole were enrolled in this study. Furthermore, postoperative subjective pain, conjunctival injection, retinal function and situation of retina were evaluated. Follow up was performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. Results: All the fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients divided into 2 groups: Group (A) 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-gauge PPV .While in Group (B) twenty five eyes of 20 patients (13 males, 65% and 7 females, 35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range: 47-62 years). Statistically, the differences between both groups regarding age and sex were insignificant. Conclusion: Advantages of sutureless vitrectomy include a reduction in operating time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration surgery

Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy

Aim: To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy as regarding safety and efficacy in pars plana vitrectomy. Patients and methods: A prospective non –randomized interventional study comparing the two vitrectomy systems in a group of disease requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL–Hayaha Eye Center (Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A) 23 –gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy (PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication, outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation (FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema or macular hole were enrolled in this study. Furthermore, postoperative subjective pain, conjunctival injection, retinal function and situation of retina were evaluated. Follow up was performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. Results: All the fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients divided into 2 groups: Group (A) 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-gauge PPV .While in Group (B) twenty five eyes of 20 patients (13 males, 65% and 7 females, 35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range: 47-62 years). Statistically, the differences between both groups regarding age and sex were insignificant. Conclusion: Advantages of sutureless vitrectomy include a reduction in operating time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration surgery

Traumatic Maculopathy with Massive Subretinal Hemorrhage after Closed-Globe Injuries: Associated Findings, Management, and Visual Outcomes

To investigate the visual outcomes of patients with traumatic maculopathy and massive subretinal hemorrhage (SRH) after closed-globe injury. Retrospective, noncomparative, and interventional case series. Twenty-four patients with traumatic maculopathy and massive SRH after closed-globe injury. In this retrospective observational case series, we included 25 eyes of 24 patients who had experienced closed-globe injury with massive SRH. The demographics, clinical characteristics, and final visual acuity (VA) of the patients. Twenty-five eyes with massive SRHs involving the macula were studied with initial VAs from light perception to 4/200. At initial presentation, vitreous hemorrhages were present in 22 eyes, hyphema in 13 eyes, lid lacerations in 11 eyes, glaucoma in 8 eyes, iridodialysis in 7 eyes, afferent pupillary defect in 6 eyes, lens dislocation or subluxation in 5 eyes, and cyclodialysis clefts and hypotony in 2 eyes. Retinal detachment developed in 7 eyes during the follow-up period. Pars plana vitrectomy usually was performed in patients with persistent vitreous hemorrhage, retinal detachment, lens dislocation, and cyclodialysis cleft with hypotony. In final visual outcomes, 7 eyes achieved favorable visual outcomes with VA of 20/200 or more. Thirteen eyes showed VA of 2/200 or less with dense macular scars or foveal atrophy. Foveal atrophy showed encompassed foveal thinning, retinal pigment epithelial clumping, and the loss of external limiting membrane (ELM), ellipsoidal zone (EZ), and interdigital zone (IZ) on spectral-domain OCT. Fundus autofluorescence demonstrated interposed, reduced, and increased autofluorescence in traumatic pigment epitheliopathy. Traumatic maculopathy and massive SRH after closed-globe injury often cause poor visual outcomes, especially in eyes with dense macular scars or foveal atrophy. Spectral-domain OCT findings in patients with good visual outcomes revealed partial to complete preservation of the foveal ELM, EZ, and IZ.

EFFICACY OF INTRAVITREAL RANIBIZUMAB INJECTIONS IN THE TREATMENT OF VITREOUS HEMORRHAGE RELATED TO PROLIFERATIVE DIABETIC RETINOPATHY.

To investigate the efficacy of intravitreal ranibizumab injections in proliferative diabetic retinopathy associated with vitreous hemorrhage (VH). A prospective study including patients with proliferative diabetic retinopathy who presented with persistent VH. Vitreous hemorrhage was graded into mild, moderate, and severe. Patients were randomized into two groups: the ranibizumab group was treated with intravitreal injections of ranibizumab and the control group was assigned to observation alone. Vitrectomy was performed if there was any aggravation of the VH in patients with mild, moderate, and severe VH or in the absence of improvement by 16 weeks in patients with moderate and severe VH. The ranibizumab group included 71 patients and the control group included 62 patients. There was a statistically significant difference in the vitrectomy rate in patients with mild-to-moderate VH (5 patients [7.04%] and 12 patients [19.35%], respectively; P = 0.04). However, there was no statistically significant difference in the overall vitrectomy rate, and in the vitrectomy rate in severe VH (17 [23.94%] and 12 [16.90%] patients in the ranibizumab group vs. 22 [35.48%] and 10 [16.13%] patients in the control group, P = 0.14 and P = 0.83, respectively). Recurrence of the VH occurred in 22 patients in the ranibizumab group and 29 patients in the control group (P = 0.06). Better visual acuity measurements were recorded on all follow-up visits in the ranibizumab group (P ≤ 0.04). Intravitreal ranibizumab injections could be considered in proliferative diabetic retinopathy patients with mild and moderate VH.