Recurrent Vitreous Hemorrhage Research Articles

Visual Outcomes of Pars Plana Vitrectomy Alone or with Intravitreal Bevacizumab in Patients of Diabetic Vitreous Haemorrhage.

To evaluate the visual outcomes of pars plana vitrectomy (PPV) alone or with intravitreal bevacizumab in patients of diabetic vitreous haemorrhage. A quasi-experimental study. Al-Ibrahim Eye Hospital, Malir, Karachi, from March to November 2018. Patients between 40-70 years of age, irrespective of gender with non-resolving dense diabetic vitreous haemorrhage were divided into two groups. Group A received injection bevacizumab 7 days before PPV surgery. Group B received no preoperative injection. Log Mar chart was used for documenting postoperative vision. All patients completed their 6 months follow-up. SPSS was used to analyse the data. Best corrected visual acuity (BCVA) was documented as improved, same, or worse. In Group A, 21 (70%) patients had improved VA; whereas, in Group B, 17 (56.6%) patients showed improved visual acuity postoperatively. Patients were examined at four weeks, three months, and six months, respectively for recurrent vitreous haemorrhage. In Group A, 25 (83.3%) patients had no vitreous haemorrhage up to six months, whereas, in Group B, 13 (43.3%) patients had no vitreous haemorrhage up to six months with p-value of 0.021. Anti VEGF injection bevacizumab before PPV in patients with non-resolving diabetic vitreous haemorrhage is good to get better results in terms of BCVA, as well as reduce the incidence of recurrent vitreous haemorrhage.

Хромовитрэктомия в лечении рецидивирующего гемофтальма при пролиферативной диабетической витреоретинопатии

Хромовитрэктомия в лечении рецидивирующего гемофтальма при пролиферативной диабетической витреоретинопатии

Clinical study on the timing of preoperative application of conbercept in proliferative diabetic retinopathy

Objective To observe the best time of application of conbercept before vitrectomy for proliferative diabetic retinopathy (PDR). Methods The data of 75 eyes of 75 cases of proliferative diabetic retinopathy who underwent vitrectomy from May 2017 to Jul. 2018 were retrospectively analyzed. All cases were divided into two groups randomly. Group A , 38 eyes of 38 cases, received intravitreal injection of Conbercept at 7 days before operation, and group B, 37 eyes of 37 cases, received intravitreal injection of Conbercept 3 days before operation. The operation time, intraoperative and postoperative complications and the visual acuity at 6 months postoperatively were observed and compared between the two groups. Results Postoperative visual acuity of the two groups were significantly improved (t=8.854, P=0.000). Postoperative recurrence of vitreous hemorrhage occurred in 1 eye (2.6%) of group A and 7 eyes (18.9%) of group B (P=0.028). Postoperative intraocular hypertension occurred in 5 eyes (13.2%) of group A and 7 eyes (18.9 %) of group B, the difference was not statistically significant (χ2 =0.463, P=0.496). The difference were not statistically significant between the two groups in operation time, intraoperative retinal hemorrhage, iatrogenic tear incidence, silicone oil or gas tamponade rate (P=0.502, 0.518, 0.304, 0.444, 0.720). Conclusion Application of Conbercept before vitrectomy can improve the visual acuity for patients with PDR. The incidence of vitreous hemorrhage in patients applicated of Conbercept at 7 days before vitrectomy can reduce the incidence of vitreous hemorrhage than that in patients applicated of Conbercept at 3 days. Key words: Conbercept, intravitreal injection; Retinopathy, proliferative diabetic; Vitrectomy

Хромовитрэктомия в лечении рецидивирующего гемофтальма при пролиферативной диабетической витреоретинопатии

Хромовитрэктомия в лечении рецидивирующего гемофтальма при пролиферативной диабетической витреоретинопатии

Safety and efficacy of intravitreal conbercept injection after vitrectomy for the treatment of proliferative diabetic retinopathy.

The aim of this study was to evaluate the safety and efficacy of intravitreal conbercept (a recombinant fusion protein that primarily targets vascular endothelial growth factors) after vitrectomy for the management of proliferative diabetic retinopathy without tractional retinal detachment (TRD). Fifty patients with non-clearing vitreous haemorrhage (VH) due to proliferative diabetic retinopathy without TRD were enroled. They were randomly divided into control and treatment groups (25 eyes to each group) after they provided informed consent. The treatment group received intravitreal conbercept (10 mg/mL, 0.5 mg) immediately after surgery, while the control group did not. The best corrected visual acuity (BCVA) and the central retinal thickness were measured. There were no significant between-group differences in baseline characteristics (P > 0.05), except in age (P = 0.003). Improvement in BCVA was significantly greater at 1, 4, 12, and 24 weeks post surgery in the treatment group than it was in the control group (P < 0.001). There were more cases in the control group who developed recurrent VH, but the recurrence rate of VH was not significantly different between the two groups at 12 and 24 weeks post surgery (P = 0.192 and 0.103). Central retinal thickness was lower in the treatment group than in the control group at 1 week (P = 0.012), 4 weeks (P = 0.01), 12 weeks (P = 0.001), and 24 weeks (P = 0.004) post surgery, which were statistically significant. An intravitreal injection of conbercept after vitrectomy improved visual acuity and seemed to reduce the recurrence of VH resulting in prompt visual recovery in the PDR patients.

Hemophilia A in a Female Patient with Recurrent Vitreous Hemorrhage

Hemophilia A in a Female Patient with Recurrent Vitreous Hemorrhage

Chinese Guideline on the Management of Polypoidal Choroidal Vasculopathy (2022)

BackgroundIn mainland China, patients with neovascular age-related macular degeneration (nAMD) have approximately an 40% prevalence of polypoidal choroidal vasculopathy (PCV). This disease leads to recurrent retinal pigment epithelium detachment (PED), extensive subretinal or vitreous hemorrhages, and severe vision loss. China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV. MethodsA total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes, regarding opinions on inactive PCV, choices of anti-vascular endothelial growth factor (anti-VEGF) monotherapy, photodynamic therapy (PDT) monotherapy or combined therapy, patients with persistent subretinal fluid (SRF) or intraretinal fluid (IRF) after loading dose anti-VEGF, and patients with massive subretinal hemorrhage. An evidence synthesis team conducted systematic reviews, which informed the recommendations that address these questions. This guideline used the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach to assess the certainty of evidence and grade the strengths of recommendations. ResultsThe panel proposed the following six conditional recommendations regarding treatment choices. (1) For patients with inactive PCV, we suggest observation over treatment. (2) For treatment-naive PCV patients, we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy. (3) For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment, we suggest later/rescue PDT over initiate PDT. (4) For PCV patients who plan to initiate anti-VEGF monotherapy, we suggest the treat and extend (T&E) regimen rather than the pro re nata (PRN) regimen following three monthly loading doses. (5) For patients with persistent SRF or IRF on optical coherence tomography (OCT) after three monthly anti-VEGF treatments, we suggest proceeding with anti-VEGF treatment rather than observation. (6) For PCV patients with massive subretinal hemorrhage (equal to or more than four optic disc areas) involving the central macula, we suggest surgery (vitrectomy in combination with tissue-plasminogen activator (tPA) intraocular injection and gas tamponade) rather than anti-VEGF monotherapy. ConclusionsSix evidence-based recommendations support optimal care for PCV patients’ management.

BIMANUAL MICROINCISION VITREOUS SURGERY FOR SEVERE PROLIFERATIVE DIABETIC RETINOPATHY: OUTCOME IN MORE THAN 300 EYES.

To evaluate the visual and anatomical outcomes and safety of bimanual microincision vitreous surgery for severe proliferative diabetic retinopathy. Retrospective review of 315 eyes of 282 patients who underwent 23-gauge or 25-gauge pars plana vitrectomy with bimanual membrane dissection for diabetic tractional detachment from January 2007 to September 2016. Minimum follow-up was 3 months, and the average duration of follow-up was 23 months (range 3-100 months; median 15 months). Outcome measures were best-corrected visual acuity, anatomical success, and postoperative complications. Postoperatively, 84.3% of eyes improved (>2 lines), 10.5% were stable, and 5.4% worsened (>2 lines). Comparing gauges, two-line improvement was seen in 87.4% of 23-gauge eyes compared with 79.7% of 25-gauge eyes (P = 0.029). Mean peak best-corrected visual acuity improved from 20/930 (1.67 ± 0.63) preoperatively to 20/120 (0.78 ± 0.63) postoperatively (P < 0.001). Primary reattachment was achieved in 310 eyes (98.4%) and final reattachment in 312 eyes (99%). Recurrent vitreous hemorrhage was the commonest postoperative complication (18.4%). Lower incidence of recurrent vitreous hemorrhage was seen with 25 gauge (13.5%) compared with 23 gauge (22%, P = 0.038). Epiretinal membrane formation (7.9%), intractable glaucoma (2.5%), and endophthalmitis (0.6%) were some of the other postoperative complications. Sustained visual improvement, anatomical restoration, and low complication rates were obtained in complex situations with bimanual microincision vitreous surgery in a large series. Visual outcomes were poorer in older age group, tractional retinal detachments involving macula, and eyes with extensive membranes and with silicone oil as tamponade. Both 23-gauge and 25-gauge groups were comparable in relation to visual improvement, anatomical success, and intraoperative and postoperative complications.

Pediatric Eales Disease: An Indian Tertiary Eye Center Experience.

To report the clinical profiles, etiologies, treatment modalities, and outcomes for Eales disease in patients younger than age 16 years in India. Retrospective review of medical records of patients with Eales disease who had a minimum 5-year follow-up period. A total of 25 eyes of 13 patients were included. Of these 13 patients, 12 (94%) had bilateral Eales disease and 11 (84.6%) were men. Mean patient age was 14.1 years (range: 11 to 16 years). Diminution of vision (36%) was the most common presenting complaint, followed by both diminutions of vision and floaters (32%). Sclerosed vessels were seen in all eyes, and 21 (84%) eyes had active periphlebitis at presentation. Neovascularization elsewhere was seen in 20 (80%) eyes and neovascularization of the optic disc was seen in 1 (4%) eye. Veno-venous shunts were found in 12 (48%) eyes, and 18 (72%) eyes had vitreous hemorrhage. All eyes received photocoagulation; 84.6% of patients received oral steroids, with 7.7% of patients treated with azathioprine and 38.4% treated with anti-tubercular therapy. Vitrectomy was performed in 36% of eyes for non-clearing vitreous hemorrhage and tractional retinal detachment. Vision improved in 7 (28%) eyes, was stable in 12 (48%) eyes, and worsened in 6 (24%) eyes. Recurrence of the disease more than five times during the 5-year follow-up period occurred in 20% of patients. Recurrent vasculitis and vitreous hemorrhage in children should raise the suspicion of pediatric Eales disease. [J Pediatr Ophthalmol Strabismus. 2018;55(4):270-274.].

Surgical Treatment of Diabetic Recurrent Vitreous Hemorrhage and Traction Retinal Detachment

Although the irreversible proliferative complications of diabetes are less visible with anti-vascular endothelial growth factor (anti-VEGF) agents, surgical treatment is still important for these groups of patients; because of the high frequency of diabetes mellitus. The most common indications for vitreoretinal surgery for proliferative diabetic retinopathy are vitreous hemorrhages and tractional retinal detachments. This review summarized the surgical treatment of these two complications.

Outcomes of Anterior Chamber Intraocular Lens Implantation in Patients Undergoing Pars Plana Vitrectomy

To assess outcomes and complication rates in patients undergoing pars plana vitrectomy (PPV) and implantation of an anterior chamber intraocular lens (ACIOL). Retrospective chart review. A total of 50 eyes that underwent secondary ACIOL placement in the setting of concurrent PPV from October 2000 to August 2016 were included. A retrospective chart review was conducted. The primary outcome measure was the occurrence of postoperative complication including persistently elevated intraocular pressure, persistent or recurrent hyphema, persistent or recurrent vitreous hemorrhage, persistent corneal edema, or persistent uveitis, macular edema, epiretinal membrane, lens dislocation, retinal tear, or retinal detachment. The secondary outcome measure was best-corrected visual acuity (BCVA). Postoperative complications occurred as follows: persistently elevated intraocular pressure in 4 eyes (8%), persistent corneal edema in 1 eye (2%), persistent postoperative uveitis in 1 eye (2%). Seven eyes (14%) had new macular edema and 2 eyes (4%) had new epiretinal membranes after combined PPV and ACIOL surgery. No patient had persistent postoperative hyphema, vitreous hemorrhage, retinal tear, retinal detachment, or lens dislocation after ACIOL placement. Mean preoperative BCVA was 20/200 (logarithm of the minimum angle of resolution 0.96) and improved to 20/40 (logarithm of the minimum angle of resolution 0.28, P ≤ 0.0001) at 1 year postoperatively. Whereas there is a recent emphasis on new intraocular lens placement techniques in the setting of PPV including sutured and scleral-fixated intraocular lenses, ACIOL placement in the setting of concurrent PPV is a safe procedure, with few eyes developing long-term complications if careful case selection is employed.

Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials

Background/aimsTo evaluate the efficacy of antivascular endothelial growth factor (anti-VEGF) agents pretreatment before vitrectomy for patients with complicated proliferative diabetic retinopathy (PDR).MethodsThe PubMed, Embase and the Cochrane Central Register of...

Intravitreal Bevacizumab for Proliferative Sickle Retinopathy: A Case Series

Purpose: To report outcomes of intravitreal bevacizumab therapy for proliferative sickle retinopathy (PSR). Methods: A retrospective, interventional case series. Five eyes of 5 patients with PSR were managed with intravitreal bevacizumab therapy over a 13-year period at a single institution. Results: Four patients had sickle cell-hemoglobin SC disease and 1 had sickle cell-beta thalassemia disease. Four of the patients treated with intravitreal bevacizumab injection were treated for recurrent vitreous hemorrhage and 1 was treated for new peripheral sea fan neovascularization. In those patients treated for vitreous hemorrhage, there was improvement in visual acuity as early as 2 weeks after treatment. Only 2 of the patients had documented recurrent vitreous hemorrhage during the period of follow-up after the initial injection. In 1 patient, the vitreous hemorrhage did not recur until 13 months after the injection. All patients showed an anatomic response to intravitreal bevacizumab therapy with partial regression of the peripheral sea fan neovascularization. All patients tolerated the injections without any complications. Conclusions: Intravitreal bevacizumab injections appear to be well tolerated and may be an effective treatment of PSR. Regression of peripheral sea fan neovascularization and decreased duration of vitreous hemorrhage may be observed. Large-scale randomized controlled trials are needed to further clarify the role of bevacizumab in PSR.

Idiopathic retinal vasculitis, arteriolar macroaneurysms and neuroretinitis (IRVAN): case series of three patients with multimodal imaging

PurposeTo describe the clinical presentation, disease progression, treatment and complications of IRVAN.MethodsRetrospective review of three patients with a diagnosis of IRVAN seen at the Birmingham and Midland Eye Centre between 2010 and 2017. Multimodal imaging investigations included wide‐field fluorescein angiography, optical coherence tomography, and indocyanine green angiography.ResultsA total of 6 eyes from 3 patients with bilateral disease were included. All six eyes were treated with panretinal photocoagulation (PRP). One eye received a dexamethasone implant for refractory macular oedema and exudation. One eye was treated with Avastin injections for persistent optic disc neovascularization. All 3 patients were treated with oral steroids at some point in the course of their disease and one was subsequently immunosuppressed with mycophenolate mofetil. Visual outcomes varied. One patient maintained excellent visual acuity of 6/6 in both eyes at 72‐months follow‐up. The second patient experienced progressive visual loss from 6/9 right eye, 6/6 left eye at presentation; to 6/18 right eye, 6/60 left eye at 12 months follow‐up due to macular exudation despite aggressive PRP and intravitreal Ozurdex. The third patient deteriorated from 6/5 right eye, 6/4 left eye at presentation to 6/60 right eye at 6 months, despite aggressive PRP. He had recurrent vitreous haemorrhages in the right eye secondary to NVD despite further interventions with Avastin injections; seven years after presentation, vision remained at 6/60 right eye and 6/18 left eye.ConclusionsThe cadence of progression of IRVAN can vary greatly, despite aggressive treatment with PRP, intravitreal steroids, and anti‐VEGF agents. We observed variation in disease progression both among patients as well as within the same individual, supporting an individualized approach to therapy.

Unilateral Eales' disease a case report.

Introduction. Eales disease is an idiopathic peripheral vascular occlusive disease characterized by inflammation, ischemia, and retinal neovascularization and is hallmarked by recurrent vitreous hemorrhages and vision loss. Case report. We present a case of a 48-year-old female with recurrent floaters and decreased vision in her right eye. The onset of symptoms was in 2007 when a diagnose of retinal vasculitis was made. She had no accompanying systemic signs and symptoms and no history of ocular trauma or previous tuberculosis infection. The eye condition was managed only with intermittent focal laser treatment, because the general treatment with steroids was not efficient and poorly tolerated. After the laser treatment, the visual acuity completely recovered and there was no recurrence of vitreous hemorrhage. The case particularity was the unilaterality after 9 years from the onset.

Recurrent Vitreous Hemorrhage Secondary to Sulcus Positioning of a One-Piece Acrylic Intraocular Lens Haptic: Report of 3 Cases and Management With Retrocapsular Haptic Repositioning

Three pseudophakic patients presented with recurrent, unilateral vitreous hemorrhage, one of which also had uveitis, glaucoma, and hyphema, consistent with “uveitis–glaucoma–hyphema (UGH)-Plus” syndrome. Arcuate transillumination defects secondary to inadvertent placement of 1 intraocular lens (IOL) haptic in the sulcus were identified in each case. The second haptic and optic were located in the capsular bag. The IOLs were all single-piece foldable acrylic lenses with square-edge haptic design. Surgical repositioning of the malpositioned haptic from the sulcus to the retrocapsular space resulted in the resolution of the recurrent vitreous hemorrhage. This series highlights the fact that recurrent vitreous hemorrhage secondary to iris chafing, with or without UGH, may occur in cases where a square-edge IOL haptic is placed in the sulcus. Vitrectomy with repositioning of the malpositioned IOL is a simple alternative to IOL exchange in these cases.

Efficacy of vitrectomy combined with selective retinal photocoagulation for diabetic retinopathy

Objective To observe the efficacy of pars plana vitrectomy (PPV) combined with selective retinal photocoagulation (SRP) in the treatment of proliferative diabetic retinopathy (PDR) with vitreous hemorrhage. Methods Two hundred eyes of 190 patients with PDR and vitreous hemorrhage were enrolled in this study.All patients were treated with 23-gauge PPV combined with retinal photocoagulation and intravitreal injection of Lucentis and triamcinolone acetonide.All patients were divided randomly into two groups: the contral group, 108 eyes of 102 cases, received panretinal photocoagulation(PRP) during surgery and the observation group, 92 eyes of 88 cases, received SRP during surgery. All patients were followed up for 6 months.The effect were compared between the two groups. Results BCVA of observation group was better than that of contral group at 1 week, 1 month and 3 months after surgery.The difference was statistically significant(P=0.000). The difference in BCVA was not statistically significant between the two groups at 6 months after surgery(P=0.094). The central macular thickness(CMT) of observation group was lower than that of contral group at 1 week and 1 month after surgery, the difference was statistically significant(P=0.000). The difference was not statistically significant at 3 months after surgery between the two groups(P=0.349). The number of times of retinal photocoagulation in observation group was more than that in contral group.The difference was statistically significant(P=0.000). The incidence of recurrent vitreous hemorrhage and neovascular glaucoma in observation group were higher than those in contral group.The difference were not statistically significant(P=0.526, 0.470). Conclusion Under the auxiliary of anti-vacular endothelial growth factor and triamcinoloneacetonide, microincision vitrectomy with SRP is better than microincision vitrectomy with PRP to treat patients with vitreous hemorrhage and PDR in reducing postoperative macular edema and improve the visual acuity. Key words: Retinopathy, diabetic, proliferative; Vitreous hemorrhage; Vitrectomy, 23-gauge; Photocoagulation, retinal, selective, pan

Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

INTRODUCTION. The aim of our study is to describe the anatomical and functional results of pars plana vitrectomy (PPV) among diabetic patients treated due to tractional retinal detachment (TRD) or non-clearing vitreous haemorrhage (VH). MATERIALS AND METHODS. A retrospective analysis was made of clinical data of 45 eyes treated with 23G PPV for TRD (17 eyes) or VH (28 eyes). Preoperative and final visual outcomes and postoperative complications were recorded. The mean follow-up period was 12 months. RESULTS. The postoperative visual acuity (VA) improved significantly in 60% of eyes, but remained unchanged or was worse in 40%. Improvement of VA was more pronounced in the VH group. PPV was performed with silicone oil tamponade in 66.5%, air tamponade in 29%, and gas tamponade in 4.5%. Postoperative complications included: retinal re-detachment (seven eyes), secondary glaucoma (nine eyes), and recurrent VH (two eyes). CONCLUSIONS. PPV is an effective treatment method of complications of severe proliferative diabetic retinopathy inter alia the TRD and VH. Because surgical management of TRD and VH is demanding, anatomical and functional results are limited by complications.

Ophthalmic endoscope: A novel diagnostic imaging tool

The purpose of the study was to evaluate the feasibility of ophthalmic endoscope as a diagnostic tool. This was a prospective, non-comparative, interventional clinical study of 11 consecutive patients who underwent endoscopy-assisted management for ocular pathologies. We used a fused fiber-optic type of endoscope to visualize areas of the eye which were not seen clearly, due to media opacity, through conventional viewing systems like indirect ophthalmoscopy or wide angle viewing system. Eleven cases were enrolled in the study. Five patients underwent endoscopic examination of the fundus prior to penetrating keratoplasty (PKP) or keratoprosthesis. In one out of these 5 cases, PKP was differed due to pale optic nerve. Patient number 6, 7 &amp; 8 were cases of recurrent vitreous hemorrhage. In these patients, endoscope was used to inspect the sclerotomy from inside and to remove incarcerated vitreous and fibro-vascular membrane. Patient number 9 was a case of poorly dilating pupil undergoing cataract surgery. Endoscope was used in this patient to locate the exact position of haptics of PCIOL. In cases 10 and 11, endoscope was used to localize ciliary sulcus and to document the position of haptics of sclera fixated IOL. Conclusion: The ophthalmic endoscope provides valuable information by illuminating, video recording, and by providing clear view of areas not visible by conventional viewing systems. It can help in management strategies in selected cases.

Outcomes of transconjunctival sutureless 27-gauge micro-incision vitrectomy surgery in diabetic vitreous haemorrhage.

Objective:To evaluate the visual outcomes of 27-gauge transconjunctival sutureless vitrectomy surgery and its complications in patients with diabetic vitreous hemorrhage.Methods:A quasi-experimental study was conducted where eighty seven eyes of 87 uncontrolled type II diabetes mellitus patients presenting with diabetic vitreous hemorrhage were selected to undergo 27-gauge transconjunctival sutureless micro-incision vitrectomy surgery. Main outcome measured was best corrected visual acuity (BCVA). Post-operative complications were also screened for at each visit. The follow ups were at post-operative day one, one month, three months and six months respectively.Results:Out of 87 patients, 52 (59.8%) were males and 35 (40.2%) were females. The mean age of the patients was 52.32 ± 6.78 years (95% CI: 53.13 - 55.57). For most of the patients, the BCVA improved progressively with each subsequent follow up visit. Pre-operative BCVA was 1.01 ± 0.206 logMar, compared to BCVA at final follow up of 0.44 ± 0.231 (p-value < 0.001). Six (6.9%) patients developed recurrent vitreous hemorrhage during the study period, four (4.6%) developed cataract, one (1.1%) had increased intraocular pressure and sub conjunctival hemorrhage was present in two (2.3%).Conclusion:27-gauge micro-incision vitrectomy surgery is an effective sutureless surgery with favorable outcomes, in terms of vision, in patients with diabetic vitreous hemorrhage. The associated complications are few which can be easily managed.