Subhyaloid Hemorrhage Research Articles

Causes of Vision Loss Associated with Dengue Fever in Bihar, India - A Case Series.

The incidence and geographic distribution of dengue has increased dramatically in recent years across various parts of the world. Previously, ocular findings in dengue fever were considered rare. We report a spectrum of ocular manifestations presenting with vision loss in the last dengue epidemic in an eastern state of India. This is a retrospective interventional case series of patients with vision loss who were diagnosed with dengue eye disease in the 2022 epidemic. Systemic and ophthalmic examinations were completed on all patients and were analyzed. Fifteen patients had presented with vision loss. The mean age was 41.7 ± 10.8 years, and patients were mostly males. Three patients presented with panophthalmitis and orbital cellulitis. Eight patients were diagnosed with optic neuropathy. Four patients had macular involvement: macular chorioretinitis, macular subhyaloid hemorrhage, and macular hemorrhages in two patients. All patients with optic neuropathy gave a history of mild fever and had remained undiagnosed. The rest had been diagnosed with the more severe dengue hemorrhagic fever. Vision recovered partially or fully in patients with optic neuropathy and macular disease. No eye could be salvaged in any panophthalmitis patients. Thrombocytopenia (platelet count <100 × 109 per liter of blood) was significantly associated with ocular hemorrhage and panophthalmitis, but thrombocytopenia was not significantly seen in optic neuropathy. We conclude that optic neuropathy may be an underreported cause of vision loss in dengue fever. An eye examination is advocated in all patients with dengue eye disease.

EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022

Introduction &amp; ObjectivesFiltration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy isgenerally a safe and effective procedure, complications can occur. The purpose of the study was todescribe the early postoperative complications in patients who had undergone filtration surgery.&#x0D; MethodsThis study was a retrospective study that uses secondary data from electronic medical records ofpatients who had filtration surgery between January 1, 2020, and December 31, 2022, in KariadiHospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, andtype of glaucoma. The incidence of early postoperative complications was described up to 3 weeks offollow-up.&#x0D; Results287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) hadphaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCEtrabeculectomy.Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type ofglaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%)experienced an early complication with trabeculectomy being more common (17.42%) thancombined surgery. The commonest complication found was hypotony in 69 eyes (24%). Othercomplications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), blebleakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinalhaemorrhage (0.35%).&#x0D; ConclusionThis study found the most common early postoperative complication of filtration surgery washypotony. This complication occurs frequently after trabeculectomy.

EARLY POSTOPERATIVE COMPLICATION FOLLOWING FILTRATION SURGERY IN DR. KARIADI GENERAL HOSPITAL SEMARANG 2020-2022

Introduction and Objective: Filtration surgery is the most frequent surgery in managing glaucoma. Although trabeculectomy is generally a safe and effective procedure, complications can occur. The purpose of the study was to describe the early postoperative complications in patients who had undergone filtration surgery. Methods: This study was a retrospective study that uses secondary data from electronic medical records of patients who had filtration surgery between January 1, 2020, and December 31, 2022, in Kariadi Hospital Semarang. Preoperative data include age, gender, visual acuity, intraocular pressure, and type of glaucoma. The incidence of early postoperative complications was described up to 3 weeks of follow-up. Results: 287 eyes were obtained from 266 patients who underwent filtration surgery. 168 eyes (58.5%) had phaco-trabeculectomy, 117 eyes (40.77%) had trabeculectomy and 2 eyes (0.7%) had ECCE-trabeculectomy. Primary angle closure glaucoma (126 eyes, 43.9%) was the most common type of glaucoma treated with filtration surgery. During the 3-week follow-up period, 93 eyes (32.4%) experienced an early complication with trabeculectomy being more common (17.42%) than combined surgery. The commonest complication found was hypotony in 69 eyes (24%). Other complications include hyphema (3.14%), transient intraocular pressure elevation (3.14%), bleb leakage (2.09%), suprachoroidal haemorrhage (0.7%), subhyaloid haemorrhage (0.35%) and retinal haemorrhage (0.35%). Conclusion: This study found the most common early postoperative complication of filtration surgery was hypotony. This complication occurs frequently after trabeculectomy.

Terson Syndrome: A Rare, Treatable Visual Loss After Subarachnoid and Intraventricular Hemorrhage

Abstract&#x0D; Introduction : Intracranial pathologies commonly affect vision through optic neuropathy. However, visual loss could be due to vitreous hemorrhage as in Terson syndrome. This report warns us rare cases of visual loss after intracranial hemorrhage that requires totally different management than more commonly found optic neuropathies.&#x0D; Case Illustration : Female, 46 years old, had a severe headache and decreased consciousness two days later. CT angiography revealed wide subarachnoid hemorrhage and intraventricular hemorrhage causing hydrocephalus. She received emergency lumbar drainage followed by digital subtraction angiography and flow diverter device. Postoperative she regained consciousness, CT scan showed reduced ventricular size without residual hemorrhage, yet visual acuity of left eye reduced to hand movement and did not improve until one month later. Ophthalmologic examination showed vitreous hemorrhage of the left eye. Right eye was normal. Vitrectomy was planned to clear the vitreous hemorrhage.&#x0D; Discussion : Terson syndrome is intraocular hemorrhage associated with subarachnoid hemorrhage, cerebral hemorrhage, or traumatic brain injury. The proposed mechanisms were transmission of subarachnoid blood to the optic nerve sheath and rapid effusion of cerebrospinal fluid into the optic nerve sheath due to sudden increase of intracranial pressure. It compresses central retinal vein, causing vascular rupture. The manifestations could be vitreous, subhyaloid, subretinal, or intraretinal hemorrhage. Visual prognosis is good in those resolved spontaneously or receiving vitrectomy in nonresolving cases.&#x0D; Conclusion : Visual loss from intracranial hemorrhage or trauma could be caused by intraocular hemorrhage. It deserved different management than optic neuropathies. Prompt recognition should improve the management and the prognosis of rare cases such as Terson syndrome.

Ocular manifestations of acute myeloid leukemia during induction phase of chemotherapy: A case series

The aim of this series is to report diverse ocular features noted in patients during the induction phase in acute myeloid leukemia (AML). Three female patients undergoing induction therapy for AML reporting for various ocular complaints were examined. Detailed history, including the onset of AML and chemotherapy and any past ocular or systemic ailment, was taken. Best-corrected visual acuity, anterior segment, and posterior segment examinations were performed. Intraocular pressure was measured, and color vision was tested. Routine hematological, and biochemical investigations and imaging were done when required. Patients with abnormal parameters were referred to an oncologist for management. A varied spectrum of ocular manifestations was noted in these three female patients, including preseptal cellulitis, orbital cellulitis, and subhyaloid hemorrhages. Immediate treatment was given to patients with vision-threatening conditions in consultation with an oncologist and otorhinolaryngologist, and patients responded well to the treatment. Owing to its cytoreductive action, AML induction therapy exposes the patient to various adverse events, causing significant ocular and systemic morbidity. All the diagnosed patients of AML are recommended to undergo a baseline ocular assessment.

An outbreak of subhyaloid hemorrhage after accidental laser exposure during an Indian festival.

To report the clinical manifestations and outcomes of patients who experienced retinal damage due to accidental laser exposure during a festival in Kolhapur, Maharashtra. Consecutive patients who presented with sudden loss of vision following exposure to laser lights during a religious Indian festival (Ganapati festival) on the same day (9 September 2022) at the same location (idol visarjan procession) were identified from the medical records of various eye hospitals in Kolhapur district of Maharashtra. Eyes with persistent subhyaloid hemorrhage (SHH) were taken up for neodymium-doped yttrium aluminum garnet (Nd: YAG) posterior hyaloidotomy. Patients were examined at weekly intervals up to 1 month. Thirty-four eyes of 34 men were identified with age ranging from 18 to 27 years. The mean duration of exposure to the laser projections was 4.9 ± 1.7 h, and the mean distance from the laser source was 7.3 ± 2.7 feet. All presented with SHH involving the macula. SHH had a median size of 3 disc diameters or larger in 30 eyes (88%), and 29 (97%) of these required hyaloidotomy while one patient underwent pars plana vitrectomy. The mean visual acuity improved from 1.45 ± 0.5 log of minimum angle of resolution (logMAR; 20/560 Snellen) to 0.11 ± 0.19 logMAR (20/25 Snellen) (P < 0.001). One eye showed full-thickness macular hole with visual acuity of 20/200. We report a large number of patients experiencing laser-induced SHH, resembling an outbreak, due to exposure to a malfunctioning high-powered recreational laser during a religious festival.

Acute dacryocystitis in aplastic anemia – A case report

Immunosuppression in Aplastic anemia often leads to bacterial sepsis and pneumonias. We report a case of a 33-year female with aplastic anemia, with acute fulminant dacryocystitis. She also had anemic retinopathy in both eyes with subhyaloid hemorrhage in the left eye. The clinical presentation was as with typical acute dacryocystitis with characteristic erythema and edema inferior to medial canthus. However, there was a rapid progression to systemic sepsis. She was treated with blood and blood component transfusion and hematopoietic growth factors in addition to high-dose broad-spectrum lytic antibiotics. The patient responded initially, but clinical course subsequently deteriorated due to systemic involvement. This may have happened due to infected lacrimal sac acting as a persistent focus of infection. This is the first documented case of treatment of acute dacryocystitis in aplastic anemia.

Acute subhyaloid hemorrhage resulting in vitreomacular traction in a case of acute myeloid leukemia

Acute subhyaloid hemorrhage resulting in vitreomacular traction in a case of acute myeloid leukemia

Subhyaloid hemorrhage in Evans Syndrome.

Evans syndrome is a rare disorder characterized by autoimmune hemolytic anemia and immune thrombocytopenia. We report the first case of ophthalmic involvement in a pediatric patient with Evans syndrome, in which painless vision loss was the presenting symptom. A 15-year-old female presented with acute painless loss of vision in her right eye and was found to have bilateral subhyaloid hemorrhages. She was treated with intravenous steroids and transitioned to hydroxychloroquine. Her retinal hemorrhages resolved and her vision improved. Nontraumatic subhyaloid hemorrhage is a rare cause of vision loss in children. Evans syndrome should be considered in the differential diagnosis of such patients when hematologic abnormalities are present.

Neuro-ophthalmic Complications in Pediatric Leukemia.

Optic neuropathy in childhood leukemia occurs through multiple direct and indirect mechanisms, including leukemic infiltration of the optic nerve, infection, blood dyscrasias, or adverse effects of treatment. We aimed to characterize visual outcomes in pediatric patients with leukemia-associated neuro-ophthalmic manifestations. We retrospectively identified patients with leukemia and optic nerve pathology over 13 years by diagnostic billing codes. We collected information on demographics, presentation, treatment course, and visual outcomes directly from medical records. Of the 19 patients who met inclusion criteria, 17 (89.5%) had pseudotumor cerebri and 2 had direct optic nerve infiltration. Causes of increased intracranial pressure included central nervous system infiltration (6 of 17), hyperviscosity/leukemia (2 of 17), venous sinus thrombosis (3 of 17), medication induced (5 of 17), and bacterial meningitis (1 of 17). 47.1% (8 of 17) had papilledema at the time of leukemia diagnosis, and 94.1% (16 of 17) of patients with pseudotumor cerebri were treated with acetazolamide. At presentation, 3 patients had decreased vision secondary to macular ischemia, subhyaloid vitreous hemorrhage, or steroid induced glaucoma. Following treatment of pseudotumor cerebri, binocular visual acuity was ≥20/25 in all patients. One patient with optic nerve infiltration had a final visual acuity of count fingers in the affected eye. In our chart review, the most common mechanism of neuro-ophthalmic involvement in pediatric leukemia was elevated intracranial pressure from a myriad of causes. Visual outcomes from patients with elevated intracranial pressure were excellent. Understanding the mechanisms by which leukemia can cause optic nerve disease in pediatric patients can facilitate earlier diagnosis and treatment and potentially improve visual outcomes.

Subhyaloid Hemorrhage Caused by Laser Pointer Misuse in a Child.

Subhyaloid Hemorrhage Caused by Laser Pointer Misuse in a Child.

Eye shaped sub-hyaloidal hemorrhage. What does the eye reveal about the body?

A 62 year old female patient, with no previous history, consulted in emergency department for a sudden decrease in visual acuity of the right eye with a feeling of uneasiness and vertigo.

Valsalva Retinopathy Provoked Giant Sub-Hyaloid Hemorrhage and Management after Photocoagulation Therapy: A Case Report

Valsalva Retinopathy Provoked Giant Sub-Hyaloid Hemorrhage and Management after Photocoagulation Therapy: A Case Report

Sub-hyaloid hemorrhage due to ruptured retinal artery macroaneurysm treated with YAG hyaloidotomy.

Sub-hyaloid hemorrhage due to ruptured retinal artery macroaneurysm treated with YAG hyaloidotomy.

Leukemic retinopathy presenting as concurrent bilateral subhyaloid hemorrhage and subarachnoid hemorrhage in a patient with acute monocytic leukemia: a case report

BackgroundOphthalmic manifestations are common in patients with leukemia, developing in nearly 50% of cases. Intracranial hemorrhage is another potentially fatal complication of leukemia. In this case report, we aim to present a challenging case that involves both ophthalmic and intracranial manifestations in an individual with acute monocytic leukemia.Case presentationA 36-year-old Persian male presented to the emergency room with complaints of fever, headache, and bilateral blurred vision. The patient had been diagnosed with acute monocytic leukemia 3 months prior and had undergone four sessions of induction chemotherapy, the last of which was 10 days prior to admission. The patient was admitted to the internal medicine service, and initial lab studies confirmed pancytopenia, including severe neutropenia, anemia, and thrombocytopenia. Subarachnoid hemorrhage in the left frontal lobe was detected through spiral brain computed tomography scan. Ophthalmic examination revealed visual acuity of light perception in the right eye and 3-m finger count in the left eye. Fundus examination revealed bilateral peripapillary subhyaloid and intraretinal hemorrhages, confirming leukemic retinopathy. The patient showed significant improvement in visual acuity and hemorrhage resolution through conservative treatment and regular follow-ups after 3 months.ConclusionSimultaneous subarachnoid hemorrhage and bilateral subhyaloid hemorrhages seemed to have occurred as a result of pancytopenia. Management approach of ophthalmic manifestations of leukemia involves interdisciplinary cooperation and should be individualized on the basis of the patients’ underlying medical condition.

Nd:YAG laser vitreolysis in the treatment of premacular subhyaloid hemorrhage

Nd:YAG laser vitreolysis in the treatment of premacular subhyaloid hemorrhage

FUNDUS FINDINGS IN PATIENTS OF MILD, MODERATE AND SEVERE DEGREE OF ANAEMIA PRESENTING TO THE TERTIARY HEALTH CARE CENTRE

Purpose:To study fundus findings in patients of mild,moderate, and severe degree of anaemia presenting to the tertiary health care centre. Methods:This was a prospective observational study that involved25 patients of anemiacomplaining of blurring of vision, conjunctival pallor, pain, subconjunctival hemorrhage and eyelid swelling. Results:There were 20females and 5 males and the age group taken was 20 to 50 years.Out of 25 patients of nutritional anemia, 12 patients belonged to the age group of 20 to 30 years, out of which 10 were females and 2 weremales. 8 patients belonged to age group of 30 to 40 years, out of which 6 were females and 2 were males. 5 patients belonged to the age group of 40 to 50 years, out of which 4 were females and 1 was male.In our study, it was found that 5 patients belonged to the category of severe anemia with hemoglobin [&lt;6 gm/dl], 8 patients belonged to the category of moderate anemia with hemoglobin ranging between 6-10 gm/dl, 12 patients belonged to the category of mild anemia with hemoglobin ranging between 10-12 gm/dl.On looking for various fundus manifestations in different grades of anemia viz.mild, moderate and severe anemia, we found out that the incidence of retinal vascular changes in the form of venous dilation and tortuosity, pale disc, roth spots, macular edema,subhyaloid hemorrhages, dot – blot and flame shaped hemorrhages showed an increasing trend with increase in severity of anemia. Conclusion:There is a high prevalence of anemia in India which affects female gender more than male gender. Anemic retinopathy is not an uncommon condition but it is generally asymptomatic and gets noted incidentally during general workup of the patients. It has variable presentation in different patients with different grades of anemia.

Valsalva Retinopathy: A Case Report

Valsalva retinopathy is characterised by pre-retinal haemorrhage which presents with unilateral, sudden, painless diminution of vision. Pre-retinal haemorrhage caused by sudden rise in venous pressure was first termed as Valsalva haemorrhage by Duane TD in 1972. It is caused by rupture of superficial retinal capillaries due to increased intra-ocular venous pressure following increase in intra-thoracic or intraabdominal pressure. It resolves in few weeks or month and vision returns to normal depending on the location of the bleed on the retina. Observation, Nd:YAG (neodymium-doped yttrium aluminium garnet) laser and Argon laser hyaloidotomy, vitrectomy are effective treatment options for eyes with Valsalva retinopathy. Here we present a case of a 32 year old female with Valsalva retinopathy with subhyaloid haemorrhageafter an episode of vomiting who was treated with Nd:YAG laser hyaloidotomy with a good visual outcome.The novelty of this case report lies in the fact that although conservative management is practiced more often with similar prognosis, early intervention by Nd:YAG laser hyaloidotomycan benefit the patient with marked improvement and rapid recovery. Key words: Valsalva retinopathy, subhyaloid haemorrhage, Nd:YAG laser hyaloidotomy.

ИАГ-лазерная гиалоидопунктура при субгиалоидных кровоизлияниях (клинические случаи)

Purpose. Тo present the results of YAG laser hyaliodopuncture in patients with subhyaloid hemorrhages. Material and methods. 4 patients underwent YAG laser hyaloid puncture. These patients were followed up for at least 12 months. In all cases, YAG laser hyaloid puncture was performed with the YAG III device (Carl Zeiss Meditec AG, Germany). Hyaloid puncture was performed at a wavelength of 1064 nm through the central part of the Goldmann lens with the application of 3 to 7 pulses with a power of 1.7–2.8 mJ in the lower segment of the BGM at the point corresponding to the greatest prominence of hemorrhage. Results. In all cases, laser treatment was carried out without complications. Intensive blood flow into the vitreal cavity and subjective improvement in visual acuity were obtained during the first 2 hours after laser treatment for 3 adult patients. BCVA in the 2nd case increased from pr. certae to 0.3, in the 3 rd case from 0.2 to 0.5, in the 4 th case from 0.1 to 0.4. A defect in the posterior hyaloid membrane was determined according to SOCT. All patients had complete elimination of blood from the subhyaloid space after 1 month at the control examination. Only the 4 th patient noted periodic «floating opacities», in other cases, the patients did not complain. BCVA in 1 st and 2 nd cases was 1.0, in 3 rd and 4 th cases it was 0.8. IOP was within normal limits in all cases. Conclusion. YAG laser hyaloid puncture can be used to treat subhyaloid hemorrhages. The technique shows high efficiency when performed as soon as possible after the development of hemorrhage under the control of laboratory methods of blood analysis. Keywords: subhyaloid hemorrhage, YAG-laser hyaloid puncture.

Prevalence of Advanced Diabetic Eye Disease among diabetic patients in a tertiary care hospital in South India

Introduction:To analyze the Prevalence of advanced diabetic eye disease(ADED) among diabetic patients&#x0D; Methods:This was a prospective cross-sectional study in a tertiary care hospital. A total of 1650 patients with a history of type 2 diabetes who visited ophthalmology department were enrolled in study. History regarding socioeconomic status, literacy level, duration of diabetes, comorbidities, medications, HbA1c levels were analyzed. Visual acuity,Slit-lamp, fundus examination were done.Medical/surgical intervention was done to restore vision.&#x0D; Results: A total of 1650 patients with a history of type 2 diabetes were analyzed. Among them 327 patients had fundus changes of diabetic retinopathy, hence the prevalence of DR among diabetics was 19.81%. Out of 327 patients, 53 patients had advanced diabetic eye disease and the prevalence of ADED among Diabetics was 3.20%. The mean age of the patients was 50.91+/- 9.06years.There were 42 (79.24%)males and 11 (20.7%)females.24 (45.28%)patients had vision of 6/6 - 6/60, 28 (52.83%|) patients had vision 5/60-CFCF.15(28.30%) patients had PDR with vitreous hemorrhage.12 patients (22.64%) had PDR with subhyaloid hemorrhage,11 patients (20.75%) had PDR with FVP sparing macula,13 patients(24.52%) had PDR with FVP involving the macula,2 patients(3.77 %) had PDR with Neovascular glaucoma.34 patients (64.15%) underwent PRP,19 patients (35.84 %) needed surgical intervention.&#x0D; Conclusion: This study shows that the prevalence of diabetic retinopathy among diabetic patients was 19.81%. The prevalence of Advanced Diabetic Eye Disease among diabetic patients was 3.2%. Hence Effective implementation of primary, secondary and tertiary prevention strategies has the potential to significantly reduce blindness due to DR.