Recurrent Vitreous Hemorrhage Research Articles

Ultrasound Biomicroscopy in Pseudophakic Patients with Unexplained Recurrent Hyphema or Vitreous Hemorrhage

ABSTRACTPurpose: To describe IOL haptic with iris or ciliary body touch on ultrasound biomicroscopy (UBM) in pseudophakic patients with unexplained recurrent hyphema or vitreous hemorrhage. Methods: Retrospective chart review of 10 patients who presented with unexplained recurrent hyphema and or vitreous hemorrhage. Results: There were eight posterior chamber intraocular lenses (PCIOL) and two sulcus lenses. Four cases had a history of glaucoma; two cases which had a history of trabeculectomy were found to have some bridging vessels along the sclerostomy requiring argon laser gonioplasty. No preceding trauma or retinal pathology was found. UBM revealed haptic-ciliary body or haptic-iris touch in cases with a PCIOL and haptic-iris touch in both sulcus lens cases. One case with a PCIOL did not reveal any haptic-iris or ciliary body touch and instead displacement of the optic temporally, though haptics remained intracapsular. Conclusions: UBM is a useful tool to evaluate haptic position in pseudophakic patients with unexplained recurrent hyphema and/or vitreous hemorrhage. This is the largest existing series of patients with this clinical entity reported from a single institution.

A Case of Eales Disease in Postpartum Period

A 31-year-old female presented with visual field defect and floaters in right eye. Symptom occurred just before labor and worsened after labor. The best corrected visual acuity was 1.0 in the right eye. Fundus examination revealed retinal hemorrhage and periphlebitis in the affected eye. After 2 weeks, newly developed retinal vasculitis was observed in the fellow eye as well as in the affected eye. She was treated with systemic corticosteroid and disease activity increased while tapering corticosteroid. After adding systemic immunomodulating agent, disease activity was controlled. Retinal neovascularization was observed in previous non-perfusion area. She underwent vitrectomy in the right eye due to recurrent vitreous hemorrhage, and prophylactic laser photocoagulation was performed in the left eye.

Role of Tamponade in Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage

ABSTRACTAim: To analyze the role of tamponade in vitrectomy for proliferative diabetic retinopathy with vitreous hemorrhage. Methods: A retrospective chart analysis of patients who underwent vitrectomy for proliferative diabetic retinopathy (PDR) between 2006 and 2013, with a minimum follow-up of six months, was done. The data collected included age, gender, control of diabetes, pre- and postoperative best-corrected visual acuity (BCVA), retinal detachment, type of tamponade, and recurrence of vitreous hemorrhage (VH). Statistical analysis was done using SPSS software version 2.0 and p values <0.05 were taken as significant. Results: A total of 73 eyes of 73 patients were included. The patients were analyzed in four groups: Group 1: no tamponade; Group 2: air; Group 3: gas; Group 4: silicone oil (SO). Eighteen (24.7%), 18 (24.7%), 15 (20.5%), and 22 (30.1%) patients were in the four groups, respectively. The mean preoperative BCVA in logMAR was 1.61, 1.84, 2.25, and 2.03 and the mean change in BCVAs at six months was –0.98, –0.94, –0.97, and –0.19 in four groups, respectively. Recurrent vitreous hemorrhage was noted in 11.1%, 11.1%, 6.7%, and 9.5% of patients of four groups; it was not statistically significant. The retina remained attached in 100%, 100%, 93%, and 90% of patients in the four groups, respectively, at six months. Conclusion: The use of an intraocular tamponade in eyes with vitreous hemorrhage due to PDR was not found to be superior to no tamponade in reducing recurrent vitreous hemorrhage. Therefore, the use of a tamponade in eyes without retinal break is not beneficial.

Role of bevacizumab in the prevention of early postoperative haemorrhage after 25-gauge microincision vitrectomy surgery.

Objective:To evaluate the effect of preoperative intravitreal bevacizumab injection on the incidence of postoperative haemorrhage and visual prognosis, in patients undergoing 25-gauge micro incision vitrectomy surgery (MIVS) for diabetic vitreous haemorrhage.Methods:One hundred and twenty two eyes of 122 patients of diabetic retinopathy of both genders and aged over 18 years, who presented with non-resolving vitreous haemorrhage were enrolled for this study. All patients received an intravitreal injection of 1.25 mg/0.05 mL bevacizumab (Avastin) which was followed one week later by 25-gauge sutureless micro incision vitrectomy surgery. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative vitreous haemorrhage. Follow ups were up to six months post-operatively. IBM SPSS 21 was used for data analysis.Result:A total of 122 patients were included; 78 (63.9%) males and 44 (36.1%) females. Mean age at the time of surgery was 51.4 ± 13.66 years. The mean preoperative BCVA was 1.64 ± 0.427 logMAR which improved to 0.57 ± 0.253 logMAR at 12 months post-operatively (p-value < 0.001). Recurrent vitreous haemorrhage was seen in four patients (3.28%).one1 week before 25-gauge vitrectomy helps to reduce the incidence of early post-vitrectomy haemorrhage in diabetic patients.

Recurrent Vitreous Hemorrhage in a Case of Retinal Cavernous Hemangioma: A Rare Presentation.

Recurrent Vitreous Hemorrhage in a Case of Retinal Cavernous Hemangioma: A Rare Presentation.

THE FIGHT AGAINST TIME IN THE TREATMENT OF EALES DISEASE

Eales disease is characterized by three overlapping stages of retinal vasculitis, occlusion, and neovascularization. Diagnosis is mostly clinical, and its etiology appears to be multifactorial. A 26-year-old woman with manifesting vasculitis of the peripheral retina, retinal neovascularization, and vitreous haemorrhage is presented. Depending on the stage of the disease, its management consisted of medical treatment with corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages. Multiple delicate ocular surgeries were performed due to recurrent vitreous haemorrhage and retinal detachment. The experience acquired in this treatment is evidence of the necessity for treatment immediately after the confirmation of Eales disease. The decision to carry out intensive laser treatment and surgery at the right time could improve the prognosis of Eales disease. Acta Medica Medianae 2015;54(4):59-63.

Vitreous haemorrhage in massive hemorrhagic polypoidal choroidal vasculopathy: clinical characteristics and surgical outcomes: Vitreous hemorrhage in PCV.

BackgroundTo report the outcomes of vitreous hemorrhage (VH) associated with hemorrhagic polypoidal choroidal vasculopathy (PCV).MethodsA retrospective study of 28 eyes of 27 consecutive patients of hemorrhagic PCV with VH, which were managed surgically between January 2003 and December 2011, was performed. All patients underwent pars plana vitrectomy for VH associated with PCV. The main outcome measure was best-corrected visual acuity (BCVA) at baseline, at 1, 3 and 6 months post operatively and at last follow up.ResultsThe visual acuity measured on early treatment diabetic retinopathy study (ETDRS) chart improved in 16 eyes (57.1 %) by two or more lines, remained unchanged in nine eyes (32.1 %) and decreased in three (10.7 %) after surgery when compared to baseline VA. The mean baseline VA was 2.69 ± 0.57 logMAR units (<20/2000) which improved to 1.65 ± 0.93 logMAR units (20/800) at 1 month post operative visit and was sustained at 1.72 ± 1.12 (20/800) with an improvement of 0.96 logMAR units (p < 0.001, 95 % CI 0.54–1.37). The average postoperative follow up was for 14.2 months (range 1–84). The complications noted in postoperative follow up were cataract (n = 10), macular scaring (n = 9), organised dehemoglobinised blood (n = 7), retinal tear or detachment (n = 5), recurrent VH (n = 3) and choroidal detachment (n = 1).ConclusionMajority of patients with loss of vision due to VH secondary to hemorrhagic PCV have sustained improvement in visual acuity following surgery.

Preoperative intravitreal bevacizumab effects on the course of Pars Plana vitrectomy in diabetic vitreous hemorrhage

PurposeTo compare the rate of rehemorrhage in patients with diabetic vitreous hemorrhage (VH) undergoing pars plana vitrectomy (PPV) with versus without preoperative intravitreal bevacizumab (IVB) injectionMethodsForty patients with proliferative diabetic retinopathy (40 eyes) with an indication for primary vitrectomy were randomized to IVB group (20 eyes) or control group (20 eyes). Intravitreal bevacizumab group received intravitreal injection of 1.25 mg/0.05 mL bevacizumab, 1 week before vitrectomyResultsThe frequency of postoperative recurrent vitreous hemorrhage (5%, 1/20 vs. 40%, 8/20, P = 0.017) were significantly lower in IVB group than in control group .The number of intraoperative endodiathermy spots (0.63 ± 1.0 vs. 1.3 ± 1.4, P = 0.028) were also significantly lower in IVB group than in control group while mean bleeding frequency in IVB group was 0.7 ± 0.78 times/case with range between 0 and 2 bleeding attacks/case and mean bleeding frequency in control group was 3.12 ± 1.31 times/case with range between 3 and 6 bleeding attacks/case and the difference was statistically significant as (p &lt; 0.001). The frequency of reoperation due to recurrent vitreous hemorrhage within 4 weeks after surgery was significantly lower (P = 0.022) in IVB group (5%, 1 patient) than in control group (35%, 7/20)ConclusionsIntravitreal injection of 1.25 mg/0.05 mL bevacizumab 1 week before vitrectomy blocked vascular endothelial growth factor production in vitreous and significantly reduced the incidence of reoperation due to early postoperative recurrent vitreous hemorrhage.

RANDOMIZED CONTROLLED STUDY OF INTRAVITREAL BEVACIZUMAB 0.16 MG INJECTED ONE DAY BEFORE SURGERY FOR PROLIFERATIVE DIABETIC RETINOPATHY.

To investigate the usefulness of 0.16 mg/0.05 mL intravitreal bevacizumab (IVB) injection 1 day before vitrectomy for proliferative diabetic retinopathy. Sixty-two patients with proliferative diabetic retinopathy (66 eyes) with an indication for primary vitrectomy were randomized to IVB group (34 eyes) or sham control group (32 eyes). Intravitreal bevacizumab group received intravitreal injection of 0.16 mg/0.05 mL bevacizumab, and sham control group received sham injection 1 day before vitrectomy. Vitreous fluid was sampled before vitrectomy was started. Frequency of reoperation due to recurrent vitreous hemorrhage within 4 weeks after surgery was significantly lower (P = 0.033) in IVB group (3.1%, 1/32) than in sham control group (20.6%, 7/34). The number of intraoperative endodiathermy spots (0.63 ± 1.0 vs. 1.3 ± 1.4, P = 0.025) and frequency of postoperative recurrent vitreous hemorrhage (3.1%, 1/32 vs. 23.5%, 8/34, P = 0.017) were significantly lower in IVB group than in sham control group. Vitreous vascular endothelial growth factor concentrations were 1315.3 ± 1153.4 pg/mL in sham control group and 25.0 ± 13.6 pg/mL in IVB group (P < 0.0001). Intravitreal injection of 0.16 mg/0.05 mL bevacizumab 1 day before vitrectomy blocked vascular endothelial growth factor production in vitreous and significantly reduced the incidence of reoperation due to early postoperative recurrent vitreous hemorrhage.

Uveitis-glaucoma-hyphema syndrome associated with recurrent vitreous hemorrhage

Case reportA 61-year-old pseudophakic male with recurrent blurred vision episodes associated with uveitis, hyphema, glaucoma and vitreous hemorrhage. Iris transillumination defects and apposition of the optic and iris were found. The patient was diagnosed with uveitis-glaucoma-hyphema (UGH) syndrome. DiscussionMechanical irritation of the iris is a consequence of intraocular lens malposition and causes UGH syndrome. Occasionally it is associated with vitreous hemorrhage. Lens malposition is detected by optical coherence tomography and/or ultrasound biomicroscopy.

The effect of microincision vitrectomy and intravitreal injection of ranibizumab in the treatment of proliferative diabetic retinopathy

Objective To observe the effect of microincision vitrectomy assisted with intravitreaI injection of ranibizumab (IVR) in proliferative diabetic retinopathy (PDR) treatment. Methods This is a prospective, randomized, and comparative case series study. A total of 92 patients (92 eyes) with PDR were recruited to have microincision vitrectomy with (combined group) or without (PPV group) IVR. There are 48 eyes in the combined group and 44 eyes in the PPV group. The average operation time, iatrogenic breaks, the use of tamponade and electric coagulation, postoperative bleeding and best corrected visual acuity were comparatively analyzed among the two groups.The mean follow-up was (14.3±5.2) months. Results The average operation time was (59.4±18.5) min in the combined group and (74.6±16.2) min in the PPV group. The rate of silicone oil tamponade (χ2=4.619), inert gas tamponade (χ2=4.290), electric coagulation (χ2=8.039) and iatrogenic breaks (χ2=4.330) in the combined group were significantly decreased compared with PPV group(P<0.05). The mean logMAR BCVA was 0.83±0.44 in the combined group and 1.37±0.53 in the PPV group, which significantly improved from preoperatively (t=3.257, 3.012; P<0.05). The rate of BCVA improvement in the combined group was significantly higher than that in the PPV group (t=2.972, P<0.05). The incidence of the recurrent vitreous hemorrhage was 2.1% in the combined group and 9.1% in the PPV group (χ2=6.741, P<0.05). There was no severe complication associated with surgery, such as choroidal detachment, retinal detachment and endophthalmitis. Conclusion IVR before the microincision vitrectomy can shorten the operation time, reduce the use of electric coagulation and intraocular tamponade, and improve visual acuity for PDR patients. Key words: Diabetic retinopathy/surgery; Diabetic retinopathy/drug therapy; Antibodies, monoclonal/therapeutic use; Angiostatins/therapeutic use; Vitreoretinal surgery

The Surgical Outcomes, Complications and Predictive Surgical Factors of Diabetic Retinopathy Vitrectomy in a Large Asian Tertiary Eye Center

Purpose: To evaluate the visual, anatomical outcomes, complications and the predictive preoperative and intraoperative factors of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) in a large Asian tertiary eye center. Methods: This is a consecutive retrospective review of 106 eyes that underwent PPV for PDR complications in 2013. The functional success was defined as visual acuity of 20/200 or better while the anatomical success was defined as 360° flat retina without endo-tamponade at one year. Results: The overall functional and anatomical success was 77.4% and 94.3%, respectively. The common complications were iatrogenic break (14.2%), raised intraocular pressure (IOP) (13.2%), cataract (13.2%) and recurrent vitreous hemorrhage (12.3%). The use of intraoperative triamcinolone (OR: 0.36, p=0.04) and silicone oil (OR: 0.08, p<0.001) were associated with poorer visual success. The iatrogenic breaks occurred more often in 20G PPV than 23G PPV (OR: 5.89, p=0.02) whereas intraoperative silicone oil were associated with postoperative raised IOP (OR: 3.71, p=0.04). The use of bevacizumab was not found to reduce recurrent vitreous hemorrhage (OR: 0.53, 95%CI: 0.11-2.53, p=0.43). Conclusions: In the era of small gauge vitrectomy, the visual, anatomical outcomes and complication rates of PPV for PDR patients in Singapore had improved significantly, as compared to the Diabetic Retinopathy Vitrectomy Study.

Visual outcome of 25-gauge microincision vitrectomy surgery in diabetic vitreous haemorrhage.

Objective:To assess the visual outcome and complications of 25-gauge micro incision vitrectomy surgery (MIVS) in diabetic vitreous haemorrhage.Methods:This Quasi Experimental study was conducted at LRBT, Tertiary eye care hospital Karachi, from February 2012 to January 2013. Sixty eyes of sixty patients with uncontrolled type II diabetes mellitus (DM) were included. There were 43 (71.7%) males and 17 (28.3%) females. Age range was 40 – 60 years. All randomly selected patients underwent 25-gauge sutureless micro incision vitrectomy surgery for diabetic vitreous haemorrhage. Main outcomes measured were best corrected visual acuity (BCVA) assessed with logMAR and post-operative complications. Follow ups were at one day, one week, one month, three months and six months post-operatively.Result:Best corrected visual acuity (BCVA) gradually improved in majority of subjects in each subsequent follow up visit. Preoperative visual acuity was 1.023 ±0.226 logMAR, which was improved after final follow up to 0.457±0.256 and P-value was < 0.001. Five patients developed recurrent vitreous haemorrhage during study period, one patient developed cataract (1.7%), one (1.7%) had ocular hypotony defined as intraocular pressure < 5 mmHg and one (1.7%) developed endophthalmitis.Conclusion:25-gauge micro incision vitrectomy surgery (MIVS) is an effective sutureless parsplana vitrectomy surgery which has good visual outcome in diabetic vitreous haemorrhage with minimum manageable complications.

Ultra-widefield fluorescein angiographic findings in patients with recurrent vitreous hemorrhage after diabetic vitrectomy.

To analyze differences in ultra-widefield fluorescein angiography (UWFFA) findings between patients with recurrent postvitrectomy diabetic vitreous hemorrhage (PVDVH) and patients with non-PVDVH (NPVDVH). Patients were categorized as PVDVH when vitreous hemorrhage recurred after diabetic vitrectomy. Age-matched control diabetic patients in whom vitreous hemorrhage did not recur after vitrectomy were assigned to the NPVDVH group. Baseline characteristics were compared between groups. Also peripheral angiographic findings such as peripheral neovascularization, nonperfusion, and late peripheral vascular leakage were analyzed by UWFFA. A total of 46 eyes were included this retrospective study: 22 with PVDVH and 24 with NPVDVH. Preoperative, 3-month postoperative, and final-visit best corrected visual acuity (BCVA) were not different between the two groups. The rate of peripheral neovascularization was significantly different (PVDVH 40.9%, NPVDVH 8.3%, P = 0.010). The rate of peripheral nonperfusion was significantly greater in PVDVH eyes than in NPVDVH eyes (81.8% vs. 37.5%, P = 0.002). The rate of late peripheral vascular leakage was also significantly greater in PVDVH eyes (90.9% vs. 29.2%, P < 0.001). These differences in peripheral angiographic findings were not seen within the conventional Early Treatment Diabetic Retinopathy Study (ETDRS) 7 standard fields. Ischemic index was also significantly higher in the PVDVH group than in the NVDVH group. Compared with diabetic vitrectomized eyes that did not have recurring vitreous hemorrhage, PVDVH eyes had a higher rate of peripheral neovascularization, nonperfusion, and late peripheral vascular leakage. These differences were not found within the conventional ETDRS 7 standard fields. Therefore, it is important to assess peripheral retinal vessels by UWFFA after diabetic vitrectomy. Furthermore, in cases of peripheral neovascularization, peripheral nonperfusion, and late peripheral vascular leakage, additional treatment may be necessary to prevent PVDVH.

INTRAVITREAL BEVACIZUMAB FOR POSTOPERATIVE RECURRENT VITREOUS HEMORRHAGE AFTER VITRECTOMY FOR PROLIFERATIVE DIABETIC RETINOPATHY

To describe the experience of authors using intravitreal bevacizumab (IVB) for eyes with recurrent vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy. Chart review was performed on eligible eyes from the Illinois Retina Associates' patient database that had at least 6 months of follow-up after receiving IVB in the operative eye for recurrent VH after vitrectomy for proliferative diabetic retinopathy. Twelve eyes of nine patients were included in the study and none required repeat vitrectomy for recurrent VH. Mean follow-up was 22 months (range, 8-42). A mean of 8.1 IVB (range, 1-18) were given. The mean number of recurrent VH was 4 (range, 2-8), and a mean of 3.5 of these VHs (range, 1-8) were clear at the appointment after an injection, typically in 4 to 6 weeks. Patients with history of multiple recurrent VH received prophylactic IVB, and repeated injections at regular intervals were associated with increased time period without recurrent VH. Intravitreal bevacizumab was a safe and effective adjunct in this series for the management of recurrent VH after vitrectomy for proliferative diabetic retinopathy. No patients required repeat vitrectomy for recurrent VH, and prophylactic IVB was associated with longer periods of clear vitreous in the late postoperative period.

Parasitic eye infection by Ascaris lumbricoides: Case report

The parasitic infection is an affection of the body as well as the eye with parasites, protozoa's, worms and ectoparasites, with world incidence of 30%. These diseases are chronic, systemic diseases because of weak innate immunity and ability of parasites to evade immune answer of the host or increasing the resistance to the adaptive immunity of the host. Parasites can evade immunity of the host by: antigens variations, forming cysts, changing the hosts and by synthesis of some cytokines, which decrease immunity of the host. Ascaris lumbricoides is the largest intestinal nematode parasitizing man. The worm is known to cause subconjunctival mass, granulomatous iridocyclitis, choroiditis, recurrent vitreous hemorrhage, chronic dacryocystitis and invasion into the subretinal space. The goal of this case was to analyze the affection of the eye, caused by the Ascaris lumbricoides as very rare ocular pathology.

Dexamethasone Intravitreal Implant for Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis

To present the short-term favorable clinical results with the dexamethasone intravitreal implant in a patient with florid idiopathic retinal vasculitis, aneurysms, and neuroretinitis syndrome (IRVAN). A 26-year-old man presented with significant bilateral deterioration of vision due to vitreous hemorrhage and neuroretinitis with a background of vasculitis and neovascularization. The patient was initially treated with high doses of oral steroids (80 mg prednisolone), which were gradually tapered, and also received extensive argon laser photocoagulation in ischemic areas in both eyes. Despite vigorous treatment and an initial positive response to treatment, pars plana vitrectomy was eventually needed to address the recurrent vitreous hemorrhages in the left eye. Consequently, visual acuity improved from 0.1 to 0.2 (Snellen) and there was no relapse of vitreous hemorrhage. Persistent macular edema was noted, however, and it was decided to treat with a dexamethasone 0.7 mg intravitreal implant. Following the dexamethasone implant OS, visual acuity improved significantly from 0.2 to 0.5 (Snellen), the patient reported much less distortion, and there was marked reduction in central retinal thickness from 467 to 234 microns. The patient remains in remission without any exudation in the macula at 4 months follow-up. Dexamethasone 0.7 mg intravitreal implant appears to be a safe and effective solution in the treatment of macular edema in patients with IRVAN syndrome and could possibly be a treatment option for other cases of inflammatory induced macular edema.

Vitrectomy With or Without Preoperative Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy: A Meta-Analysis of Randomized Controlled Trials

To compare safety and functional outcomes of vitrectomy with or without preoperative intravitreal bevacizumab (IVB) for proliferative diabetic retinopathy (PDR). A meta-analysis of randomized controlled trials. PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register were searched to identify potentially relevant randomized controlled trials. A total of 394 participants with 414 eyes in 8 trials were analyzed using RevMan 5.1 software. The primary measures included intraoperative bleeding, total surgical time, and early and late recurrent hemorrhage. Vitrectomy with IVB pretreatment achieved shorter overall surgical time (mean difference=-26.89 minutes, 95% confidence interval [CI]-31.38 to-22.39, P < .00001) and smaller number of endodiathermy applications (mean difference=-3.46, 95% CI-6.43 to-0.49, P= .02) compared to vitrectomy alone. The IVB group was also associated with less intraoperative bleeding (odds ratio [OR]= 0.10; 95% CI 0.02 to 0.46; P= .003) and recurrent vitreous hemorrhage within first month (OR= 0.35; 95% CI 0.21 to 0.58; P< .0001), but the proportion of recurrent vitreous hemorrhage after the first month was comparable between both groups. There were no significant differences in other complication rates between the 2 groups, with the exception of iatrogenic retinal break, which was more likely with the vitrectomy-alone group (OR= 0.27, 95% CI 0.12 to 0.63, P= .003). Results were robust to sensitivity analyses. Adjuvant intravitreal injection of bevacizumab prior to vitrectomy in PDR patients significantly eased the procedure, diminished intraoperative complications, and reduced early postoperative hemorrhage without increasing the risk of vision-threatening complications. Further trials should determine the optimal interval and dosage for IVBinjection.

The Role of Intraoperative Bevacizumab for Prevention of Postoperative Vitreous Hemorrhage in Diabetic Vitreous Hemorrhage

To assess the effect of intravitreal bevacizumab (IVB) on the incidence of postoperative recurrent vitreous hemorrhage (VH) in eyes operated for diabetic VH when injected at the end of the surgery. A prospective, comparative clinical trial was conducted on a consecutive series of patients requiring vitrectomy for diabetic nonclearing VH. Intravitreal bevacizumab (2.5 mg/0.1 mL) was injected at the completion of surgery. Patients underwent best-corrected visual acuity (VA), applanation tonometry, and biomicroscopic anterior and posterior segment evaluation for VH grading. Postoperative visits were performed at the first day, first week, first month, third month, and sixth month. The VH was graded at each visit, and the rate of postoperative VH and VA improvement and potential complications were evaluated and compared between the groups. A total of 72 eyes of 66 patients were included. Thirty-four eyes were enrolled in the IVB group and 38 eyes were enrolled in the control group. The rate of postoperative VH did not differ significantly between the groups at any postoperative visit (p>0.05). Three eyes (8.8%) in the IVB group and 5 eyes (13.1%) in the control group had postoperative VH throughout the follow-up period and only one eye from each group underwent a second surgery. Postoperative VA significantly increased in both groups but did not differ significantly between the groups at any postoperative visit (p>0.05). Intravitreal bevacizumab does not seem to have any beneficial effect on the incidence of postoperative VH in eyes operated for diabetic VH when injected at the end of surgery.

Fibrovascular Ingrowth After 25-Gauge Transconjunctival Vitrectomy in Proliferative Diabetic Retinopathy

The authors describe two patients with proliferative diabetic retinopathy bilaterally who were treated with transconjunctival 25-gauge pars plana vitrectomy (PPV) for dense vitreous hemorrhage (VH). After 4 and 10 months, respectively, both developed recurrent VH. They were initially managed with in-office gas-fluid exchange and anti-VEGF intravitreal injection. Soon after gas bubble resorption, the VH recurred. Color external photos revealed engorged episcleral vessels superotemporally, and ultrasound biomicroscopy confirmed the presence of fibrovascular ingrowth (FVI) at the sclerotomy site in both patients. They were successfully treated with a slightly modified 25-gauge PPV technique. Although FVI is well-recognized following conventional 20-gauge vitrectomy, this report is the first to detail FVI arising after small-gauge transconjunctival vitrectomy.