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2.
Vestn Oftalmol ; 140(1): 72-78, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38450469

RESUMO

The article presents a clinical case of bilateral Terson syndrome caused by the manifestation of acute myeloid leukemia. A 32-year-old man complained of a sharp decrease in vision in both eyes. Spontaneous subarachnoid hemorrhage occurred secondary to acute myeloid leukemia. Uncorrected visual acuity (UCVA) amounted to OD=0.01, OS=0.005. The anterior segment was normal in both eyes, voluminous immobile white-gray mass measuring 7-9 DD that completely covered the macula (intense hyperechoic cell suspension with a volume of about 1/2 of the vitreous cavity, ultrasound B-scan) were visualized in the posterior pole of the vitreous body of both eyes under conditions of maximum drug-induced mydriasis. Diagnosis: vitreous hemorrhage due to subarachnoid hemorrhage in both eyes secondary to acute myeloid leukemia. Vitrectomy was performed in both eyes. UCVA increased to 0.05 in both eyes. Vitrectomy contributed to improvement of visual functions and patient quality of life.


Assuntos
Leucemia Mieloide Aguda , Hemorragia Vítrea , Masculino , Humanos , Adulto , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Qualidade de Vida , Corpo Vítreo , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/diagnóstico , Vitrectomia
3.
Arq Bras Oftalmol ; 87(2): e20220334, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38451685

RESUMO

PURPOSE: This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy. METHODS: This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed. RESULTS: Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up. CONCLUSIONS: The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Retinopatia Diabética/cirurgia , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Estudos Retrospectivos , Hemorragia , Olho
4.
J Int Med Res ; 52(3): 3000605241233125, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38460551

RESUMO

Terson syndrome refers to intraocular haemorrhage that occurs due to subarachnoid bleeding associated with an acute increase in intracranial pressure. No previous study has reported a delayed macular hole (MH) secondary to Terson syndrome. A 17-year-old boy visited our department and presented with vitreous bleeding and a history of subarachnoid haemorrhage. Sub-internal limiting membrane (ILM) haemorrhage with ILM detachment and intraretinal haemorrhage were detected during pars plana vitrectomy. Additionally, a delayed MH was detected 1 week after the surgery. There was no sign of MH closure during a 2-month follow-up. Subsequently, an MH massage was performed to close the MH. Our findings suggest that a delayed MH can occur secondary to Terson syndrome. Elevated hydrodynamic pressure and hydrostatic pressure, which are caused by sub-ILM and intraretinal haemorrhages of the fovea, contribute to the formation of an MH. Additionally, ILM peeling may cause damage to the macula and facilitate the formation of MHs. Although the MH may close by itself, early surgical intervention is recommended when there is no sign that the MH will close spontaneously because a prolonged MH can lead to retinal damage.


Assuntos
Macula Lutea , Perfurações Retinianas , Masculino , Humanos , Adolescente , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Acuidade Visual , Macula Lutea/cirurgia , Retina , Vitrectomia/efeitos adversos , Hemorragia Vítrea/cirurgia , Hemorragia Vítrea/complicações , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 103(3): e36963, 2024 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-38241585

RESUMO

Vitreous hemorrhage (VH) is one of the main causes of vision loss in diabetic retinopathy (DRP). Early surgery increases the visibility of the retina, allowing early recognition of DRP complications and additional treatments. One of the most important reasons affecting success after surgery is recurrent vitreous hemorrhage (RVH). We aimed to investigate the risk factors for RVH after early 25G vitrectomy in diabetic VH. Eighty eyes of eighty patients who underwent early 25G PPV surgery with a diagnosis of VH due to proliferative diabetic retinopathy (PDR) were included in this retrospective study. Vision acuity changes and intraocular pressure (IOP) changes were compared. The effect of arterial hypertension (HT), coronary artery disease (CAD), preoperative antiglaucomatous usage, and anticoagulant usage on RVH was investigated. A value of P < .05 was accepted as statistically significant. Postoperative RVH was observed in 18 (22.5%) patients. There was no correlation between the age of the patients and the development of postoperative RVH (r = -0.197, P = .08). The rate of HT and the mean HbA1C levels were found to be higher in the patients who developed RVH than in those who did not (P = .04 and < 0.001, respectively). The presence of CAD, preoperative glaucoma disease, and the use of anticoagulants did not have any effect on RVH (P = .229, 0.843, 0.932, respectively). HT and increased HbA1c were found to be risk factors for RVH in VH patients who underwent 25G vitrectomy in the early period in our study.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Vitrectomia/efeitos adversos , Retinopatia Diabética/complicações , Retinopatia Diabética/cirurgia , Retinopatia Diabética/diagnóstico , Estudos Retrospectivos , Hemoglobinas Glicadas , Retina , Fatores de Risco , Diabetes Mellitus/etiologia
6.
Acta Ophthalmol ; 102(3): e296-e301, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-37431955

RESUMO

PURPOSE: To explore whether varying degrees of vitreous haemorrhage (VH) and calcification act as risk factors for enucleation in patients with advanced retinoblastoma (RB). METHODS: Advanced RB was defined by the international classification of RB (Philadelphia version). Basic information for retinoblastoma patients diagnosed as groups D and E in our hospital between January 2017 and June 2022 was reviewed by logistics regression models. Additionally, a correlation analysis was performed, excluding variables with a VIF (variance inflation factor) >10 from the multivariate analysis. RESULTS: A total of 223 eyes diagnosed with RB were included in assessing VH and calcification; of these, 101 (45.3%) eyes experienced VH, and 182 (76.2%) eyes were found to have calcification within the tumour through computed tomography (CT) or B-scan ultrasonography. Ninety-two eyes (41.3%) were enucleated, of which 67 (72.8%) had VH and 68 (73.9%) calcification, both of which were significantly relevant to enucleation (p < 0.001*). Other clinical risk factors, such as corneal edema, anterior chamber haemorrhage, high intraocular pressure during treatment and iris neovascularization, correlated significantly with enucleation (p < 0.001*). Multivariate analysis included IIRC (intraocular international retinoblastoma classification), VH, calcification and high intraocular pressure during treatment as independent risk factors for enucleation. CONCLUSIONS: Despite identifying different potential risk factors for RB, there remains significant controversy concerning which patients require enucleation, and the degree of VH varies. Such eyes need to be evaluated carefully, and management with appropriate adjuvant therapy may improve the outcome of these patients.


Assuntos
Calcinose , Neoplasias da Retina , Retinoblastoma , Humanos , Lactente , Retinoblastoma/diagnóstico , Retinoblastoma/cirurgia , Retinoblastoma/patologia , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/cirurgia , Neoplasias da Retina/patologia , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Estudos Retrospectivos , Calcinose/complicações , Calcinose/diagnóstico , Calcinose/cirurgia , Enucleação Ocular/métodos
7.
Arch Soc Esp Oftalmol (Engl Ed) ; 99(2): 62-66, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38013130

RESUMO

BACKGROUND: The most common complication after vitrectomy is the rebleeding in vitreous cavity. It is important to detect the different factors that can increase the vitreous rebleeding rate in these patients. OBJECTIVE: To carry out a retrospective review of the rate of vitreous rebleeding after vitrectomy or phacovitrectomy. METHOD: Retrospective, descriptive and comparative study of patients with a diagnosis of proliferative diabetic retinopathy with phacovitrectomy or vitrectomy procedure. Personal background data, type of surgical intervention and grade of the surgeon who carried out the procedure were obtained. RESULTS: 1227 files of diabetic patients with vitrectomy or phacovitrectomy were reviewed. 65% presented systemic arterial hypertension. The average glomerular filtration rate was 63.50 (±32.36) ml/min/1.73 m2 and glycosylated hemoglobin (HBA1C) of 8% (4.6 to 15%). In the comparison of variables, a significant difference in the rate of vitreous rebleeding was obtained comparing phacovitrectomy with vitrectomy. (p = 0.003), in the relationship between vitrectomy with vitreous rebleeding, an odds ratio of 1.44 was obtained. CONCLUSION: The results obtained show a lower rate of rebleeding in patients undergoing phacovitrectomy in patients with proliferative diabetic retinopathy.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Estudos Retrospectivos , Retinopatia Diabética/complicações , Retinopatia Diabética/cirurgia , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Diabetes Mellitus/cirurgia
8.
Retina ; 44(4): 680-688, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38011844

RESUMO

PURPOSE: To investigate the effectiveness of two regimens of ranibizumab-assisted pars plana vitrectomy in the treatment of patients with proliferative diabetic retinopathy. METHODS: This is a prospective, 6-month, randomized controlled trial. Eighty patients with 87 eyes requiring pars plana vitrectomy treatment for proliferative diabetic retinopathy were included and randomly divided into a 1.0-mg injection group and a 0.5-mg injection group. The ranibizumab was delivered intraoperatively, at the close of surgery. The vitreous hemorrhage grade, best-corrected visual acuity, central macular thickness, and safety data were assessed to Month 6. RESULTS: The 1.0-mg injection group had a milder grade and a lower reoccurrence rate of early postoperatively vitreous hemorrhage than the 0.5-mg injection group (35.0% and 63.4%, respectively, P = 0.0195). The mean best-corrected visual acuity of two groups was significantly improved from baseline to 6 months after surgery, 1.60 ± 0.72 Logarithm of the Minimum Angle of Resolution (LogMAR) (<20/200) to 0.47 ± 0.49 LogMAR (20/59) for the 1.0-mg injection group and 1.51 ± 0.69 LogMAR (<20/200) to 0.50 ± 0.31 LogMAR (20/63) for the 0.5-mg injection group, but there was no significant difference between the two groups ( P = 0.74). There was no significant difference in the mean decrease in central macular thickness and probability of postoperative adverse events between the two groups. CONCLUSION: Intravitreal injection of 1.0 mg of ranibizumab after pars plana vitrectomy compared with the recommended dose of 0.5 mg significantly reduced the recurrence and severity of early postoperative vitreous hemorrhage in patients with proliferative diabetic retinopathy. It also contributed to the early recovery of visual acuity after surgery and did not increase postoperative adverse events.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Retinopatia Diabética/tratamento farmacológico , Injeções Intravítreas , Estudos Prospectivos , Ranibizumab/efeitos adversos , Ranibizumab/uso terapêutico , Resultado do Tratamento , Vitrectomia/efeitos adversos , Hemorragia Vítrea/cirurgia
9.
Int Wound J ; 21(4): e14611, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38156741

RESUMO

The utilization of 27-G TSV, or 27-Gauge Transconjunctival Sutureless Vitrectomy, poses distinct difficulties in the context of paediatric patients, particularly those younger than 14 years old, on account of the dearth of exhaustive documentation concerning the efficacy and results of these operations. Therefore, this retrospective study was to evaluate the safety and efficacy of 27-G TSV in paediatric patients, with emphasis on management of intraoperative and postoperative complications and postoperative wound healing. A total of 54 eyes of 52 paediatric patients who underwent 27-G TSV at Sichuan Provincial People's Hospital were included in the study. The average duration of follow-up was 9.32 ± 3.35 months. The complication with the highest incidence rate was Rhegmatogenous Retinal Detachment (RRD), which was detected in 27.8% cases. Familial Exudative Vitreoretinopathy (FEVR) and Persistent Fetal Vasculature (PFV) each accounted for 16.7% of the cases. Retinopathy of Prematurity (ROP) and Vitreous Haemorrhage (VH) constituted 11.1% and 14.8%, respectively, of the reported cases. Lens injury (1.9%), cannula slippage (7.4%) and wound leakage (5.6%) were intraoperative complications. Iatrogenic retinal detachment occurred at 3.7%. Hypotony (10.8% of patients), vitreous haemorrhage (9.3%), cataract formation (9.3%), ocular hypertension (8.1%) and retinal detachment (5.6%) were postoperative complications. Effective management strategies were executed, such as performing in situ trocar puncture to address cannula slippage and promptly suturing to address wound leakage. 27-G TSV exhibited promise as the therapeutic alternative for range of vitreoretinal disorders in paediatric patients, accompanied by complications that were controllable during and after the procedure. Strict preoperative planning and precise surgical technique are indispensable in order to maximize patient outcomes and guarantee effective wound healing and recovery within this particular demographic.


Assuntos
Descolamento Retiniano , Recém-Nascido , Humanos , Criança , Adolescente , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Hemorragia Vítrea/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Técnicas de Sutura , Cicatrização
10.
Indian J Ophthalmol ; 72(Suppl 1): S22-S26, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38131537

RESUMO

PURPOSE: To analyze the outcome of intervention versus observation for vitreous cavity hemorrhage occurring after a 2-month period of blood-free cavity (late postoperative vitreous cavity hemorrhage-POVCH) in eyes operated by vitrectomy for complications of proliferative diabetic retinopathy (PDR). METHODS: This study was a 10-year retrospective, observational, multi-center study involving eight major vitreoretinal surgical centers across India from January 2010 to December 2019. The primary objective of the study was to assess the visual and clinical outcomes of various management approaches for late POVCH. The key secondary objective was to determine the best management option that prevented recurrence. Patients with follow-up of less than 6 months of POVCH management were excluded. RESULTS: The occurrence of late POVCH was studied in 261 eyes. The median time to occurrence was 7 months (range: 2-87) postvitrectomy/silicone oil removal. The majority (58%) experienced a single, nonrecurring POVCH event. Visual acuity outcome was independent of all management approaches (P = 0.179; mean follow-up 20.7 ± 14.1 months). With watchful observation, spontaneous resolution was noted in 83% (60/72 eyes) of eyes in 81.5 days (interquartile range, 169.75). Silicone oil injection was most effective in preventing recurrence (P < 0.001). CONCLUSION: The current treatment practice of late POVCH management in PDR suggests that watchful observation for at least 3 months could be as efficacious as any surgical intervention.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Vitrectomia/efeitos adversos , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Retinopatia Diabética/complicações , Estudos Retrospectivos , Óleos de Silicone , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia
11.
PLoS One ; 18(11): e0293543, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37972038

RESUMO

BACKGROUND: Vitreous hemorrhage from proliferative diabetic retinopathy can cause severe vision loss. DRCR Retina Network Protocol AB was a randomized clinical trial comparing intravitreal aflibercept versus vitrectomy with panretinal photocoagulation and found no difference in the average rate of visual recovery over 104 weeks. Herein, we describe patient-reported outcome measures from Protocol AB. METHODS: Secondary analysis of a multicenter (39 sites) randomized clinical trial. The Work Productivity and Activity Impairment Questionnaire was administered at 4, 12, 24, 36, 52, 68, 84, and 104 weeks. Main outcomes were mean change in activity impairment and work productivity loss over 24 and 104 weeks (area under the curve). RESULTS: Mean (SD) activity impairment at baseline was 58% (27%) in the aflibercept group (N = 99) and 56% (30%) in the vitrectomy group (N = 105). The mean reduction in activity impairment from baseline over 24 weeks was 21% (25%) in the aflibercept group and 27% (31%) in the vitrectomy group (adjusted difference = -6.8% [95% CI, -12.7% to -0.9%], P = .02); over 104 weeks, the adjusted mean difference was -3.1% (95% CI, -9.2% to 3.0%, P = .31). Mean work productivity loss at baseline was 51% (28%) in the aflibercept group (N = 44) and 58% (30%) in the vitrectomy group (N = 43). The mean reduction in work productivity loss from baseline over 24 weeks (area under the curve) was 19% (23%) in the aflibercept group and 31% (24%) in the vitrectomy group (adjusted difference = -8.3% [95% CI, -16.8% to 0.2%], P = .06); over 104 weeks, the adjusted mean difference was -9.1% (95% CI, -18.4% to 0.2%, P = .05). CONCLUSIONS: Participants with vitreous hemorrhage from proliferative diabetic retinopathy had less activity impairment over 24 weeks when treated initially with vitrectomy and panretinal photocoagulation versus intravitreal aflibercept. The trend was similar for work productivity but not statistically significant. By 104 weeks, the improvements were similar in the two treatment groups. TRIAL REGISTRATION: ClinicalTrials.gov NCT02858076.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Inibidores da Angiogênese/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Retinopatia Diabética/terapia , Retinopatia Diabética/tratamento farmacológico , Injeções Intravítreas , Retina , Acuidade Visual , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia
14.
Medicine (Baltimore) ; 102(40): e35364, 2023 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-37800778

RESUMO

To compare the visual outcomes of early and late vitrectomy for breakthrough vitreous hemorrhage (VH) associated with exudative age-related macular degeneration (exudative AMD) and polypoidal choroidal vasculopathy (PCV). A retrospective chart review was performed with data of all patients diagnosed with exudative AMD and PCV-related breakthrough VH who underwent early or late vitrectomy (within or after 3 months, respectively). Demographic data and best-corrected visual acuity (BCVA) at baseline, and 1, 3, 6, and 12 months postoperatively were recorded and analyzed. Overall, 105 eyes with breakthrough VH were examined and categorized in either the early or late vitrectomy group. In the early and late vitrectomy group, LogMAR BCVA improved from 2.15 ±â€…0.08 and 2.07 ±â€…0.14 at baseline to 1.26 ±â€…0.09 and 1.27 ±â€…0.14 at 12 months, respectively (P < .001). Between early and late vitrectomy, the PCV subgroup demonstrated improved LogMAR BCVA at 1 year, but there was no statistically significant (P = .754). Conversely, the LogMAR BCVA improvement at 1 year in the early vitrectomy group demonstrated statistically significant differences from the late vitrectomy group (P = .025) in the exudative AMD subgroup. Both, early and late vitrectomy can improve visual acuity in patients with breakthrough VH secondary to exudative AMD and PCV. However, early vitrectomy is more beneficial for breakthrough VH-associated exudative AMD.


Assuntos
Degeneração Macular , Hemorragia Vítrea , Humanos , Hemorragia Vítrea/cirurgia , Hemorragia Vítrea/complicações , Vasculopatia Polipoidal da Coroide , Vitrectomia , Estudos Retrospectivos , Degeneração Macular/complicações , Degeneração Macular/cirurgia , Degeneração Macular/tratamento farmacológico , Angiofluoresceinografia , Tomografia de Coerência Óptica , Injeções Intravítreas
15.
Korean J Ophthalmol ; 37(6): 477-484, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37899285

RESUMO

PURPOSE: To evaluate the role of performing photocoagulation up to ora serrata during vitrectomy in preventing recurrent vitreous hemorrhage (VH) in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: This retrospective, nonrandomized study included 60 eyes from 60 patients who had undergone PPV for VH due to PDR. These patients were divided into two groups: group 1, those who underwent photocoagulation up to ora serrata using the scleral indentation technique during surgery; and group 2, those who did not undergo scleral indentation when photocoagulation and underwent photocoagulation up to vortex veins. Their hospital records were analyzed to investigate the recurrence rate of VH, the time until recurrence of VH after surgery, logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) measured before surgery and at 1, 2, and 3 years after surgery, and the occurrence of complications such as neovascular glaucoma (NVG) during follow-up. RESULTS: Group 1 exhibited lower recurrence rate of VH (2 of 30 [6.7%] vs. 10 of 30 [33.3%], p = 0.01) and lower occurrence of postoperative NVG (2 of 30 [6.7%] vs. 8 of 30 [26.7%], p = 0.038) compared with group 2. There were no statistically significant differences in logMAR BCVA measured at 1, 2, and 3 years between the two groups (at 1 year: 0.54 ± 0.43 vs. 0.54 ± 0.44, p = 0.954; at 2 years: 0.48 ± 0.47 vs. 0.55 ± 0.64, p = 0.235; at 3 years: 0.51 ± 0.50 vs. 0.61 ± 0.77, p = 0.200). Logistic regression analysis showed that among several factors that could affect recurrence rate of VH, only range of photocoagulation performed was a statistically significant factor (odds ratio, 0.119; 95% confidence interval, 0.022-0.659; p = 0.015). CONCLUSIONS: Photocoagulation treatment over a wider range with scleral indentation could be a beneficial adjunct procedure for preventing postoperative recurrent VH following diabetic vitrectomy.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Vitrectomia/métodos , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/prevenção & controle , Hemorragia Vítrea/cirurgia , Estudos Retrospectivos , Retina , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Retinopatia Diabética/complicações , Fotocoagulação/efeitos adversos
16.
Retin Cases Brief Rep ; 17(5): 591-594, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37643048

RESUMO

BACKGROUND/PURPOSE: To describe diagnostic characteristics and management of exudative macular detachment, a rare complication of pars plana vitrectomy and endolaser for diabetic vitreous hemorrhage. METHODS: Case report including multimodal imaging. RESULTS: Forty-seven-year-old man with diabetes mellitus Type 2 and proliferative diabetic retinopathy underwent uncomplicated 23-gauge pars plana vitrectomy, Triesence-assisted hyaloid peeling, fill-in endolaser, and intravitreal bevacizumab injection in the left eye for nonclearing visually significant vitreous hemorrhage. On the first postoperative day, patient developed significant macular subretinal fluid. Multimodal imaging revealed numerous pigment epithelial detachments around optic nerve, and subretinal fluid throughout the macula on optical coherence tomography in the absence of retinal breaks on widefield raster, late deep leakage on fluorescein angiography, and corresponding hyperautofluorescence in the same region. Diagnosed with macular exudative retinal detachment, patient was treated with topical and systemic corticosteroids, with gradual resolution of subretinal fluid and visual acuity improvement. DISCUSSION: Exudative retinal detachment following diabetic pars plana vitrectomy with endolaser has been described in as many as 8.78% of cases, however may be missed in the early postoperative period. Multimodal imaging including multiple pigment epithelial detachments on optical coherence tomography, hyperautofluorescence, and late deep leakage on fluorescein angiography can help differentiate this condition from rhegmatogenous retinal detachment and central serous chorioretinopathy, and guide management to include corticosteroids.


Assuntos
Diabetes Mellitus Tipo 2 , Macula Lutea , Descolamento Retiniano , Masculino , Humanos , Pessoa de Meia-Idade , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Vitrectomia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Diabetes Mellitus Tipo 2/complicações
17.
Retina ; 43(11): 1980-1987, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37418640

RESUMO

PURPOSE: To investigate the safety and efficacy of vitrectomy pars plana vitrectomy in managing intraocular complications relating to vasoproliferative tumors of the retina (VPL). METHODS: Retrospective study. 17 patients with VPL who underwent vitrectomy at Sheffield Teaching Hospital NHS Trust from 2005 to 2020 were included. Patient demographics, clinical characteristics, intraoperative data, and surgical outcomes were collected and evaluated. RESULTS: The mean age was 52 years. Indications for pars plana vitrectomy included epiretinal membrane (n = 7), vitreous hemorrhage (n = 5), retinal detachment (n = 3), diagnostic (n = 1), and others (n = 1). After pars plana vitrectomy, 14/17 (82.4%) have stabilized vision and 3/17 (17.6%) deteriorated. Subgroup analysis of epiretinal membrane peel had good outcomes with 6/7 (85.7%) noticing improvement or stabilization of symptoms and mean logarithm of minimal angle of resolution visual acuity improved from 0.719 [6/30] ± 0.267 [6/12] to 0.476 [6/19] ± 0.271 [6/12]. Patients undergoing surgery for vitreous hemorrhage also had good outcomes with resolution (and no recurrence) of the hemorrhage in 3/5 (60%) and 5/5 (100%) with one or more surgeries, respectively. Outcomes for retinal detachment surgery were logarithm of minimal angle of resolution 2.126 [HM] ± 0.301 [6/12] preoperatively and 1.185 [6/95] ± 0.522 [6/19] postoperatively, with one recurrence of retinal detachment. In the epiretinal membrane group, three patients had adjunctive treatment for VPL intraoperatively and four patients had none, and no difference found between the two groups in outcome or complications. Tumor with thickness of ≥2 mm exhibited inferior visual outcomes compared with <2 mm ( P < 0.05). CONCLUSION: This is one of the largest data sets in looking at outcomes of vitrectomy for complications of VPL. Pars plana vitrectomy is effective and safe in managing VPL-related intraocular complications with good outcomes and a low rate of complications, especially for patients with epiretinal membrane and vitreous hemorrhage.


Assuntos
Membrana Epirretiniana , Neoplasias , Descolamento Retiniano , Humanos , Pessoa de Meia-Idade , Vitrectomia , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Membrana Epirretiniana/etiologia , Membrana Epirretiniana/cirurgia , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Estudos Retrospectivos , Complicações Pós-Operatórias/cirurgia , Retina , Neoplasias/cirurgia , Resultado do Tratamento
18.
Retina ; 43(9): 1506-1513, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37294906

RESUMO

PURPOSE: To report the outcomes of pars plana vitrectomy for vitreous hemorrhage (VH) associated with retinal vein occlusion and to identify prognostic indicators. METHODS: Interventional, retrospective consecutive case series between 2015 and 2021. RESULTS: The study included 138 eyes of 138 patients (64 female and 74 male); 81 patients had branch retinal vein occlusion and 57 had central retinal vein occlusion. The mean age was 69.8 years. The mean duration between the diagnosis of VH and surgery was 79.6 ± 115.3 (range, 1-572) days. The mean follow-up was 27.2 months. The logarithm of the minimum angle of resolution visual acuity significantly improved from 1.95 ± 0.72 (Snellen equivalent, 20/1782) to 0.99 ± 0.87 (20/195) at 6 months and to 1.06 ± 0.96 (20/230) at the final visit (both P < 0.001). The visual acuity at 6 months improved by three or more lines in 103 eyes (75%). Postoperative complications during follow-up included recurrent VH in 16 eyes (12%) (of which 8 eyes underwent reoperations), rhegmatogenous retinal detachment in six eyes (4%), and new neovascular glaucoma in three eyes (2%). Worse final visual acuity was significantly associated with older age ( P = 0.007), concurrent neovascular glaucoma ( P < 0.001), central retinal vein occlusion ( P < 0.001), worse preoperative visual acuity ( P < 0.001), postoperative new neovascular glaucoma ( P = 0.021), and postoperative retinal detachment ( P < 0.001). The duration of VH was not associated with visual outcomes ( P = 0.684). Preoperative antivascular endothelial growth factor injections and tamponade did not prevent postoperative recurrent VH. CONCLUSION: Pars plana vitrectomy is effective for VH associated with retinal vein occlusion, regardless of the duration of hemorrhage. However, pre-existing risk factors and postoperative sequelae may limit visual recovery.


Assuntos
Glaucoma Neovascular , Descolamento Retiniano , Oclusão da Veia Retiniana , Humanos , Masculino , Feminino , Idoso , Oclusão da Veia Retiniana/complicações , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/cirurgia , Descolamento Retiniano/cirurgia , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia , Prognóstico , Vitrectomia/efeitos adversos , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento
19.
BMC Ophthalmol ; 23(1): 215, 2023 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-37189104

RESUMO

BACKGROUND: The role of anticoagulation or antiplatelet on post-vitrectomy vitreous hemorrhage (POVH) in patients with proliferative diabetic retinopathy (PDR) is rarely investigated in the small-gauge vitrectomy era. We investigate the relationship between the long-term use of those medications and POVH in a group of PDR patients. METHODS: A retrospective cohort study was carried out in a group of PDR patients who underwent small-gauge vitrectomy in our center. The baseline data on diabetes, diabetic complications, long-term use of anticoagulants and antiplatelet agents, ocular findings, and vitrectomy details were collected. The occurrence of POVH was recorded during at least three-month follow-up. Factors related to POVH were analyzed using logistic analysis. RESULTS: During a median follow-up of 16 weeks, 5% (11/220) of patients had POVH, and 75 had received antiplatelet or anticoagulation agents before the operation. Factors related to persistent POVH were the use of antiplatelet or anticoagulation agents (5.98, 1.75-20.45, p = 0.004), the presence of myocardial revascularization (130.65, 3.53-4834.50, p = 0.008), the presence of coronary artery disease (CAD) treated with medicine (56.52, 1.99-1604.06, p = 0.018), and younger age (0.86, 0.77-0.96, p = 0.012). For those receiving preoperative antiplatelet or anticoagulation agents, the probability of developing POVH was higher in the patients whose previous therapy was adjusted compared to those with continued therapy (p = 0.02 by Log-rank test). CONCLUSIONS: We identified long-term use of anticoagulation or antiplatelet medication, the presence of CAD, and younger age as three independent factors related to POVH. In PDR patients on long-term antiplatelet or anticoagulation medications, particular attention should be given to controlling intraoperative bleeding, and follow-up for POVH should be scheduled.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Hemorragia Pós-Operatória , Hemorragia Vítrea , Humanos , Anticoagulantes/uso terapêutico , Retinopatia Diabética/complicações , Retinopatia Diabética/cirurgia , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Vitrectomia/efeitos adversos , Hemorragia Vítrea/etiologia , Hemorragia Vítrea/cirurgia
20.
Front Endocrinol (Lausanne) ; 14: 1098165, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36896181

RESUMO

Purpose: Intravitreal Conbercept (IVC) has been shown to be effective in treating proliferative diabetic retinopathy (PDR) as an adjuvant in pars plana vitrectomy (PPV); however, the best timing of IVC injection remains unknown. This network meta-analysis (NMA) sought to ascertain the comparative efficacy of different timings of IVC injection as an adjuvant to PPV on PDR. Methods: A comprehensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library to identify relevant studies published before August 11, 2022. According to the mean time of IVC injection before PPV, the strategy was defined as very long interval if it was > 7 days but ≤ 9 days, long interval if it was > 5 days but ≤ 7 days, mid interval if it was > 3 days but ≤ 5 days, and short interval if it was ≤ 3 days, respectively. The strategy was defined as perioperative IVC if IVC was injected both before and at the end of PPV, and the strategy was intraoperative IVC if injected immediately at the end of PPV. The mean difference (MD) and odds ratio (OR) with corresponding 95% confidence interval (CI) for continuous and binary variables, respectively, were computed through network meta-analysis using Stata 14.0 MP. Results: Eighteen studies involving 1149 patients were included. There was no statistical difference between intraoperative IVC and control in treating PDR. Except for a very long interval, preoperative IVC significantly shortened operation time, and reduced intraoperative bleeding and iatrogenic retinal breaks. Long and short intervals reduced endodiathermy application, and mid and short intervals reduced postoperative vitreous hemorrhage. Moreover, long and mid intervals improved BCVA and central macular thickness. However, very long interval was associated with an increased risk of postoperative vitreous hemorrhage (RR: 3.27, 95%CI: 1.84 to 5.83). Moreover, mid interval was better than intraoperative IVC in shortening operation time (MD: -19.74, 95%CI: -33.31 to -6.17). Conclusions: There are no discernible effects of intraoperative IVC on PDR, but preoperative IVC, except for very long interval, is an effective adjuvant to PPV for treating PDR.


Assuntos
Diabetes Mellitus , Retinopatia Diabética , Humanos , Retinopatia Diabética/tratamento farmacológico , Inibidores da Angiogênese/uso terapêutico , Vitrectomia , Fator A de Crescimento do Endotélio Vascular , Hemorragia Vítrea/cirurgia , Metanálise em Rede , Diabetes Mellitus/etiologia
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