Results of office-based fluid-air exchange for postvitrectomy hemorrhage in diabetic retinopathy

ABSTRACT 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.

Ocular manifestation of vertical transmission of dengue: case report / Manifestação ocular de transmissão vertical de dengue: relato de caso

ABSTRACT A 7-week-old male delivered by cesarean section presented with a positive serology for dengue along with preretinal and retinal hemorrhages, vitreous opacities and cotton wool spots. The patient and his mother had positive serologies for Non Structural Protein 1 (NS1) by ELISA. Retinal and vitreous findings improved over a sixteen-week period. Spectral domain optical coherence tomography (OCT) showed preserved macular architecture. In this case report, we suggest that retinal and vitreous changes may be the ocular presenting features of vertically transmitted dengue in newborns, and that those findings may resolve with no major structural sequelae.

RESUMO Neonato de 7 semanas, do sexo masculino, nascido de parto cesárea, apresentou sorologia positiva para dengue com hemorragias retinianas e pré-retinianas, opacidades vítreas e manchas algodonosas. O paciente e sua mãe haviam apresentado sorologias positivas para Non Structural Protein 1 através de ELISA. Achados na retina e no vítreo melhoraram em um período de dezesseis semanas. O exame de tomografia de coerência óptica de domínio espectral demonstrou arquitetura macular preservada. Neste relato de caso, sugerimos que alterações na retina e no vítreo podem ser os achados oculares aparentes em neonatos com infecção vertical por dengue, e que estes podem se resolver sem maiores sequelas estruturais.

Prepapillary vascular loops – A new classification

Background: Prepapillary vascular loops are a type of congenital vascular anomaly seen on or around the optic disk. Patients with this condition are usually asymptomatic and are detected incidentally on routine fundus examinations. Differential diagnosis for this condition includes neovascularization of the disk and collaterals on the disk. Prepapillary capillary loops are not associated with any systemic condition. They are usually unilateral in presentation, but can rarely be bilateral. Purpose: To discuss the new proposed classification of prepapillary capillary loops. Synopsis: Prepapillary capillary loops are classified based on their location around the disk, loop characteristics such as elevation, shape, and covering, and presence of vitreoretinal traction. Highlights: The most common vascular loops are arterial in origin and rarely venous in origin. They can sometimes be associated with spontaneous and recurrent vitreous hemorrhage, branch retinal artery or vein occlusion, and subretinal hemorrhage. It is an important differential diagnosis in spontaneous vitreous hemorrhage. Treatment is symptomatic

Visual outcomes and prognostic factors following 23G vitrectomy for vitreous hemorrhage in eyes with proliferative diabetic retinopathy / Desfechos visuais e fatores prognósticos após vitrectomia 23G para hemorragia vítrea em olhos com retinopatia diabética proliferativa

ABSTRACT Purpose: We aimed to evaluate the factors influencing the visual gain following pars plana vitrectomy for vitreous hemorrhage in patients with proliferative diabetic retinopathy. Methods: A retrospective study was conducted on 172 eyes of 143 consecutive patients with diabetes mellitus between January 2012 and January 2018. Demographic data, ophthalmological findings, surgery details, and visual outcomes were gathered after consulting the patients' records. The main outcome measured was the improvement of best corrected visual acuity and the secondary outcomes measured were rebleeding and complications. Results: Best corrected visual acuity improved in 103 eyes (59.88%), worsened in 45 eyes (26.16%), and remained unchanged in 24 eyes (13.95%). Type 2 diabetes mellitus was significantly associated with better final best corrected visual acuity (p=0.0244). Previous treatment by pan-retinal laser photocoagulation or intravitreal bevacizumab determined better final best corrected visual acuity, but not significantly (p>0.05). Preoperative rubeosis iridis and neovascular glaucoma did not influence the outcomes. The lack of fibrovascular proliferation requiring dissection was a significant factor for better final best corrected visual acuity (p=0.0006). Rebleeding occurred in 37.1% of the eyes and it was not influenced by the antiplatelet drugs (p>0.05). Postoperative neovascular glaucoma was a negative prognostic factor (p=0.0037). Conclusion: The final best corrected visual acuity was influenced positively by type 2 diabetes mellitus and the absence of preoperative extensive fibrovascular proliferation and negatively by postoperative neovascular glaucoma.

RESUMO Objetivo: Avaliar os fatores que influenciam o ganho visual após vitrectomia via pars plana para hemorragia vítrea em pacientes com retinopatia diabética proliferativa. Métodos: Foi realizado um estudo retrospectivo de 172 olhos de 143 pacientes consecutivos com diabetes mellitus entre janeiro de 2012 e janeiro de 2018. Dados demográficos, achados oftalmológicos, detalhes da cirurgia e resultados visuais foram coletados através de consulta aos prontuários dos pacientes. A principal medida de desfecho foi o aumento da melhor acuidade visual corrigida e as medidas de desfecho secundário foram a recidiva da hemorragia e a ocorrência de complicações. Resultados: A melhor acuidade visual corrigida aumentou em 103 olhos (59,88%), diminuiu em 45 olhos (26,16%) e permaneceu inalterada em 24 olhos (13,95%). O diabetes mellitus tipo 2 foi significativamente associado a maiores valores finais da melhor acuidade visual corrigida (p=0,0244). O tratamento prévio por fotocoagulação panretiniana com laser ou bevacizumabe intravítreo determinou maiores valores da melhor acuidade visual final corrigida, mas não significativamente (p>0,05). A presença de rubeose iridiana pré-operatória ou de glaucoma neovascular não influenciou os desfechos. A ausência de proliferação fibrovascular com necessidade de dissecção foi um fator significativo para maiores valores da melhor acuidade visual final corrigida (p=0,0006). Ocorreu recidiva da hemorragia em 37,1% dos olhos e não foi influenciada por fármacos antiplaquetários (p>0,05). O glaucoma neovascular pós-operatório foi um fator prognóstico negativo (p=0,0037). Conclusão: O resultado final da melhor acuidade visual corrigida foi influenciado positivamente pelo diabetes mellitus tipo 2 e pela ausência de proliferação fibrovascular extensa no pré-operatório, e negativamente pela ocorrência de glaucoma neovascular pós-operatório.

Anatomical and surgical considerations and outcomes in infantile Terson syndrome

Purpose: To study the presentation and outcomes of infantile Terson syndrome (TS). Methods: This was a retrospective analysis of 18 eyes of nine infants diagnosed to have TS?related intraocular hemorrhage (IOH). Results: Nine infants (seven males) were diagnosed to have IOH secondary to TS, of which eight infants had imaging features suggestive of intracranial bleed meeting our definite criteria. Median age at presentation was 5 months. In 11 eyes of six infants with suspected birth trauma, the median age of presentation was 4.5 months (range 1–5 months) of which one baby had a history of suction cup?aided delivery and four babies had a history of seizures. Vitreous hemorrhage (VH) was noted in 15 eyes (extensive in 11 eyes). Ten of these eyes showed membranous vitreous echoes, or triangular hyperechoic space with apex at the optic nerve head (ONH) posteriorly and base at the posterior lens capsule anteriorly, with or without dot echoes in the rest of the vitreous cavity, with a configuration of “tornado?like hemorrhage” suggestive of Cloquet’s canal hemorrhage (CCH). Eight eyes underwent lens?sparing vitrectomy (LSV) and one eye underwent lensectomy with vitrectomy (LV). On follow?up, disc pallor and retinal atrophy were noted in 11 and 10 eyes, respectively. The mean follow?up was 62 months (1.5 month–16 years). Visual acuity/behavior improved in all cases at the final follow?up. Developmental delay was noted in four children. Conclusion: Unexplained and altered vitreous hemorrhage with typical ultrasonography (USG) features should raise the suspicion of CCH in TS. Despite early intervention to clear visual axis, anatomical and visual behavior may remain subnormal.

Racemose hemangioma presenting as a vitreous hemorrhage: case report / Hemangioma racemoso apresentando-se como hemorragia vítrea: relato de caso

ABSTRACT This report describes a case of retinal racemose hemangioma that first presented as a vitreous hemorrhage. The authors present the case of a 47-year-old woman with a sudden 5-day painless visual loss in her left eye. At the first visit, the best-correct visual acuities were 20/20 in the right eye and hand motions in the left eyes. Ultrasonography showed an attached retina and a massive vitreous hemorrhage. Pars plana vitrectomy was performed and a dilatation of large vessels was detected bulging from the optic disc. The best-correct visual acuities on day 30 postoperatively was 20/25 in the left eye. Fundus angiography and spectral-domain optical coherence tomography angiography showed anomalous arteriovenous communications with no intervening capillaries. The diagnosis was racemose hemangioma, an arteriovenous malformation of group 2 retina based on the Archer classification.

RESUMO Este relato descreve um caso de hemangioma racemoso da retina que se apresentou inicialmente como hemorragia vítrea. Os autores apresentam o caso de uma mulher de 47 anos com perda visual súbita e indolor 5 dias antes no olho esquerdo. Na primeira visita, a melhor acuidade visual corrigida foi de 20/20 no olho direito e movimentos das mãos no olho esquerdo. A ultrassonografia mostrou uma retina aderida e uma hemorragia vítrea maciça. Foi realizada vitrectomia pars plana, sendo detectada proliferação de grandes vasos salientes do disco óptico. A acuidade visual no dia 30 de pós-operatório foi de 20/25 no olho esquerdo. A angiografia de retina e a angiotomografia de coerência óptica de domínio espectral mostraram comunicações arteriovenosas anômalas sem capilares intermediários. O diagnóstico foi hemangioma racemoso, uma malformação arteriovenosa da retina do grupo 2 com base na classificação de Archer.

Risk factors of postoperative vitreous hemorrhage after pars plana vitrectomy for vitreous hemorrhage secondary to retinal vein occlusion / 中华眼底病杂志

Objective:To analyze the risk factors of postoperative vitreous hemorrhage (PVH) after pars plana vitrectomy (PPV) for vitreous hemorrhage (VH) secondary to retinal vein occlusion (RVO).Methods:A retrospective case-control study. A total of 195 RVO patients (195 eyes) with VH were first treated with PPV from November 2015 to December 2021 were included in this study. There were 102 males (102 eyes) and 93 females (93 eyes), with an age of (62.93±9.78) years. The patients were divided into PVH group (17 patients, 8.72%) and non-PVH group (178 patients, 91.28%) according to the occurrence of PVH. The time of occurrence of PVH was (140.33±130.85) days after PPV. All eyes were performed 23G or 25G systematic PPV by the same doctor. During the operation, different types of intraocular tamponade and intravitreal injection of anti-vascular endothelial growth factor or triamcinolone acetonide after operation were selected according to the severity of retinopathy. The follow-up time was (9.45±6.68) months. The baseline systemic parameters, ocular parameters and intraoperative parameters affecting the occurrence of PVH were analyzed. Baseline systemic parameters included sex, age, diabetes mellitus and hypertension; ocular parameters included RVO type, lens status, VH course, preoperative best corrected visual acuity and intraocular pressure; intraoperative parameters included cataract phacoemulsification, removal of internal limiting membrane, type of intraocular tamponade, type of intravitreal injection drug at the end of operation, etc. Kaplan-Meier survival analysis, and Cox univariate and multivariate regression analysis were performed to analyze the risk factors of PVH after PPV in RVO with VH patients.Results:In PVH group, the number of patients with diabetes was more than that in the non-PVH group, and the course of diabetes was longer, and differences were statistically significant. There were significant differences in RVO type, lens status and type of intraocular tamponade. Univariate Cox regression analysis showed that the combination with diabetes [odds ratio ( OR)=2.724, 95% confidence interval ( CI) 1.006-7.374, P=0.049], duration of diabetes ( OR=1.071, 95% CI 1.013-1.134, P=0.016), central retinal vein occlusion ( OR=4.387, 95% CI 1.421-13.546, P=0.010), intraocular lens ( OR=3.493, 95% CI 1.229-9.925, P=0.019), and intraocular gas tamponade ( OR=3.640, 95% CI 1.365-9.702, P=0.010) were associated with PVH. Multivariate Cox regression analysis showed that intraocular gas tamponade was independent risk factor for PVH. Conclusion:Intraocular gas tamponade can increase the risk of PVH after PPV in patients with VH secondary to RVO.

Therapeutic effect and prognostic factors of vitrectomy for proliferative diabetic retinopathy in patients with chronic renal failure / 中华眼底病杂志

Objective:To investigate the efficacy and prognostic factors of pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR) with chronic renal failure (CRF).Methods:A retrospective study. From January 2016 to June 2021, a total of 82 eyes of 58 patients diagnosed with PDR combined with CRF and treated with PPV in Department of Ophthalmology, The Second Hospital of Hebei Medical University were included in the study. There were 32 cases in males and 26 cases in females. The mean age was (48.45±10.41) years. The course of renal failure was (4.15±3.23) years, and the course of diabetes was (14.45±6.71) years. All patients undergo best-corrected visual acuity (BCVA). The BCVA examination was performed using the international standard Snellen visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity for recording. The mean number of logMAR BCVA was 2.04±0.82 (0.7-2.8). The duration of vitreous hemorrhage averaged (2.65±1.55) months. There were 38 eyes (46.3%, 38/82) with traction retinal detachment; 32 eyes had a history of panretinal photocoagulation (PRP) treatment (39.0%, 32/82). All eyes were treated with 25G PPV. Patients with traction retinal detachment were treated with intravitreal injection of anti-vascular endothelial growth factor (VEGF) 3 days before surgery. Opacification of the lens affected the operation operator combined with phacoemulsification. Biochemical indexes such as hemoglobin, glycosylated hemoglobin, albumin, creatinine, uric acid, and alternative treatment (non-dialysis/hemodialysis/peritoneal dialysis) were collected. Postoperative follow-up time was ≥6 months. χ2 test or Fisher's exact test were used for comparison between groups. A logistic regression model was used for multivariate analysis, and Spearman correlation analysis was used to evaluate the correlations between variables. Results:At 6 months after surgery, the mean logMAR BCVA was 1.16±0.57. Compared with logMAR BCVA before surgery, the difference was statistically significant ( t=-0.837, P<0.001); 44 eyes had BCVA ≥0.1 and 38 eyes had BCVA <0.1. Postoperative vitreous hemorrhage (PVH) was observed in 17 eyes after surgery (20.7%, 17/82). PVH occurred in 15 (46.9%, 15/32), 1 (2.3%, 1/44), and 1 (16.7%, 1/6) eyes in patients without dialysis, hemodialysis and peritoneal dialysis, respectively. There was significant difference between those without dialysis and those on hemodialysis ( χ2=26.506, P<0.05). There was no significant difference between peritoneal dialysis patients and those without dialysis and hemodialysis patients ( χ2=2.694, 2.849; P>0.05). PVH occurred in 3 (10.0%, 3/30) and 14 (27.0%, 14/52) eyes of vitreous cavity filled with silicone oil and perfusion fluid, respectively. The difference was statistically significant ( χ2=3.315, P<0.05); 1 (33.3%, 1/3) and 10 (71.4%, 10/14) eyes were treated with PPV again, respectively, and the difference was statistically significant ( P<0.05). Neovascular glaucoma (NVG) occurred in 12 eyes (14.6%, 12/82). Logistic regression analysis showed that age [odds ratio ( OR) =0.911, P<0.05], diabetic retinopathy (DR) stage ( OR=7.229, P<0.05), renal failure duration ( OR=0.850, P<0.05), operation time ( OR=1.135, P<0.05) was an independent risk factor for poor vision prognosis. Diabetes duration ( OR=1.158, P<0.05), renal failure duration ( OR=1.172, P<0.05) and alternative therapy were independent factors affecting the occurrence of PVH. Diabetes duration ( OR=1.138, P<0.05) and renal failure duration ( OR=1.157, P<0.05) were independent risk factors for postoperative NVG. Spearman correlation analysis showed that PVH was strongly correlated with post-operative NVG ( r=0.469, P<0.01). There was no significant correlation between blood glucose, hemoglobin, creatinine and blood urea nitrogen and prognosis of postoperative vision, PVH and NVG occurrence ( P>0.05). Conclusions:In PDR patients with CRF, DR Stage, age, renal failure course and operation duration are correlated with vision prognosis. Compared with those who do not receive alternative therapy, hemodialysis treatment can reduce the occurrence of PVH and NVG after surgery.

Anti-vascular endothelial growth factor treatment in X-linked retinoschisis with vitreous hemorrhage / 中华眼底病杂志

Objective:To review the outcome of intravitreous anti-vascular endothelial growth factor (VEGF) treatment in patients with X-linked retinoschisis (XLRS) complicated with vitreous hemorrhage (VH).Methods:A retrospective clinical study. From March 1, 2016 to April 1, 2022, 18 patients (19 eyes) diagnosed with XLRS complicated with vitreous hemorrhage in Beijing Tongren Hospital, Capital Medical University of Eye Center were included. All the patients were male, with a median age of 7.05±3.8 years. Best corrected visual acuity (BCVA) and wide-angle fundus photography were performed in all the patients. BCVA was carried out using international standard visual acuity chart, and converted into logarithm of minimum resolution angle (logMAR) in statistics analysis. According to whether the patients received intravitreal injection of ranibizumab (IVR), the patients were divided into injection group and observation group, with 11 eyes in 10 cases and 8 eyes in 8 cases, respectively. In the injection group, 0.025 ml of 10 mg/ml ranibizumab (including 0.25 mg of ranibizumab) was injected into the vitreous cavity of the affected eye. Follow-up time after treatment was 24.82±20.77 months. The VH absorption time, visual acuity changes and complications were observed in the injection group after treatment. Paired sample t test was used to compare BCVA before and after VH and IVR treatment. Independent sample t test was used to compare the VH absorption time between the injection group and the observation group. Results:LogMAR BCVA before and after VH were 0.73±0.32 and 1.80±0.77, respectively. BCVA decreased significantly after VH ( t=-3.620, P=0.006). LogMAR BCVA after VH and IVR were 1.87±0.55 and 0.62±0.29, respectively. BCVA was significantly improved after IVR treatment ( t=6.684, P<0.001). BCVA records were available in 5 eyes before and after IVR, and the BCVA values after VH and IVR were 0.58±0.31 and 0.48±0.20, respectively, with no statistically significant difference ( t=1.000, P=0.374). BCVA increased in 1 eye and remained unchanged in 4 eyes after treatment. BCVA records were available in 5 eyes before VH and after VH absorption in the 8 eyes of the observation group. LogMAR BCVA before VH and after VH absorption were 0.88±0.28 and 0.90±0.26, respectively, with no significant difference ( t=-1.000, P=0.374). After VH absorption, BCVA remained unchanged in 4 eyes and decreased in 1 eye. The absorption time of VH in the injection group and the observation group were 1.80±1.06 and 7.25±5.04 months, respectively. The absorption time of VH was significantly shorter in the injection group than in the observation group, the difference was statistically significant ( t=-3.005, P=0.018). Multivariate linear regression analysis showed that IVR treatment was significantly correlated with VH absorption time ( B=-6.66, 95% confidence interval -10.93--2.39, t=-3.40, P=0.005). In the injection group, VH recurrence occurred in 1 eye after IVR treatment. Vitrectomy (PPV) was performed in one eye. In the 8 eyes of the observation group, VH recurrence occurred in 2 eyes, subsequent PPV in 1 eye. The rate of VH recurrence and PPV was lower in the injection group, however, the difference was not statistically significant( P=0.576, 1.000). In terms of complications, minor subconjunctival hemorrhage occurred in 2 eyes and minor corneal epithelial injury occurred in 1 eye in the injection group, and all recovered spontaneously within a short time. In the injection group, 9 eyes had wide-angle fundus photography before and after IVR treatment. There was no significant change in the range of peripheral retinoschisis after treatment. No obvious proliferative vitreoretinopathy, infectious endophthalmitis, retinal detachment, macular hole, complicated cataract, secondary glaucoma or other serious complications were found in all the treated eyes, and there were no systemic complications. Conclusion:Intravitreous anti-VEGF treatment may accelerate the absorption of vitreous hemorrhage in patients with XLRS. No impact is found regarding to the peripheral retinoschisis.

25G pars plana vitrectomy combined with Dexamethasone intravitreal implants for the treatment of vitreous hemorrhage and diabetic macular edema secondary to proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical effect of 25G pars plana vitrectomy(PPV)combined with dexamethasone intravitreal implant(DEX)on the treatment of vitreous hemorrhage and diabetic macular edema(DME)secondary to proliferative diabetic retinopathy(PDR).METHODS: Prospective clinical case study. A total of 40 patients(40 eyes)with vitreous hemorrhage and DME secondary to PDR who treated in Tianjin Eye Hospital from July 2020 to January 2022 were included in the study. All eyes underwent 25G PPV and cataract phacoemulsification. The patients were randomly divided into PPV group(20 eyes)and PPV+DEX group(20 eyes). Best corrected visual acuity(BCVA), intraocular pressure, and central macular thickness(CMT)of the patients before and 1, 3, 6mo after the operation were compared.RESULTS: All patients were followed up for 6mo. The BCVA of the patients in the PPV+DEX group improved better than that of the PPV group at 1, 3 and 6mo after surgery(P&#x003C;0.05). CMT of the PPV+DEX group was lower than that of the PPV group at 1mo after operation(P&#x003C;0.05). Retinal neovascularization or CMT regression with less than 5% was found in 8 eyes in the PPV group, who were supplemented with anti-vascular endothelial growth factor, while it was found in only 1 eye in the PPV+DEX group(P&#x003C;0.05).CONCLUSION: PPV combined with DEX could yield synergies, which provide better therapeutic effect for the patients with vitreous hemorrhage and DME secondary to PDR.

Efficacy of 25G pars plana vitrectomy with Conbercept intravitreal injection at the end of surgery for early proliferative diabetic retinopathy with vitreous hemorrhage / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy and safety of intravitreal injection of Conbercept combined with 25G minimally invasive pars plana vitrectomy(PPV)at the end of surgery for early proliferative diabetic retinopathy(PDR)with vitreous hemorrhage.METHODS: A total of 60 patients(60 eyes)with PDR complicated with vitreous hemorrhage requiring PPV at the Affiliated Eye Hospital of Nanjing Medical University were retrospectively analyzed. Based on the injection timing of Conbercept, the patients were divided into 3 groups: 20 patients(20 eyes)injected at the end of the surgery(group A), 20 patients(20 eyes)injected preoperatively(group B), and 20 patients(20 eyes)without injection(group C). The differences in pre- and post-operative visual acuity, intraocular pressure, intraoperative conditions, prognosis, and complications were analyzed among the 3 groups.RESULTS: There were no significant differences in the preoperative conditions and operation time among the patients. There was no iatrogenic retinal hole or silicone oil tamponade during the operation in the 3 groups, and no recurrent retinal detachment occurred after the operations. Best corrected visual acuity(BCVA)at 1, 3 and 6mo of all groups were improved compared with those before the surgery(P<0.05), and the injection groups(group A and group B)had a significantly better postoperative improvement than the non-injection group(group C), and there were significant differences(P<0.05). The incidence of postoperative late vitreous hemorrhage(1mo after operation)in group A was significantly lower than those in groups B and C(P<0.05). The central retinal thickness of the operated eyes in the injection groups(groups A and B)was significantly lower than that in the non-injection group(group C)at 1, 3 and 6mo after operation(P<0.05).CONCLUSION: Conbercept injection at the end of the surgery and preoperative injection are both safe and effective for early PDR and can significantly improve postoperative visual acuity. However, Conbercept injection at the end of surgery can reduce the risk of late vitreous hemorrhage recurrence, leading to better PPV outcomes and improving patients' retinal and visual function and quality of life.

Ultrasonic fragmentation for removing thick organized clots during diabetic vitrectomy – A novel technique

A 65?year?old male with proliferative diabetic retinopathy (PDR) and non?clearing vitreous hemorrhage underwent 25G pars plana vitrectomy (PPV). A large disk of thick organized blood of 5 disk diameter (DD) size was encountered in subhyaloid space. All attempts including lower cut rates to remove this disk using a 25G cutter turned futile. We used a 20G fragmatome to safely remove this hard clot from vitreous cavity in 50 s. Surgical time for removal of similar clot of 3 DD by 25G cutter in another eye was 5 min. Removal of thick clotted subhyaloid blood by ultrasonic fragmentation during diabetic vitrectomy is a safe, faster, and useful maneuver.

Retinal vasoocclusive spectrum following COVID-19

The coagulation abnormalities and thromboembolic complications of coronavirus 2 (SARS-CoV-2) are now a well-established fact. The hypercoagulable state, the tendency for thromboembolism, and a cytokine surge state have been the exclusive reasons for multiorgan failure and other morbidities that have been regularly reported in COVID-19 patients. Ocular involvement in patients with active disease and those who have recovered is uncommon but not rare. We report a case series of four patients with CRVO, BRVO, CRAO, and vitreous hemorrhage in patients with proven COVID-19 infection and no other systemic ailments. The case series also tries to correlate the elevated D-dimer values, which signify a plausible prothrombotic state with the vaso-occlusive phenomenon in the retina leading to significant visual morbidity.

Efficacy of minimally invasive vitreous surgery combined with or without anti-VEGF drug injection in PCV complicated with vitreous hemorrhage / 中华实验眼科杂志

Objective:To compare the clinical effects of minimally invasive vitreous surgery with and without anti-vascular endothelial growth factor (VEGF) drugs for polypoid choroidal vascular disease (PCV) complicated with vitreous hemorrhage.Methods:A cohort study was performed.Thirty-six consecutive cases (36 eyes) with PCV combined with vitreous hemorrhage who underwent 25G minimally invasive vitreous surgery in Xuzhou First People's Hospital from June 2015 to June 2020 were enrolled.According to surgical methods, the patients were divided into pars plana vitrectomy (PPV) group (24 eyes) receiving vitrectomy only and PPV+ anti-VEGF group (12 eyes) receiving vitrectomy first and intravitreal injection of anti-VEGF drugs one week after the operation.All patients were followed up for at least 6 months.The best corrected visual acuity (BCVA) and central retinal thickness (CRT) of the two groups before treatment, 1 month after treatment and at the last follow-up were measured and compared.Postoperative complications such as recurrence of vitreous hemorrhage and macular scar formation were recorded.This study followed the Declaration of Helsinki and was reviewed and approved by the Medical Ethics Committee of Xuzhou First People's Hospital (No.xyyll[2021]014).Written informed consent was obtained from each patient before surgery.Results:Statistically significant differences were found in BCVA between the two groups before and after treatment ( Fgroup=8.552, P=0.006; Ftime=31.775, P<0.001).The BCVA of the two groups at 1 month after operation and at the last follow-up were significantly improved in comparison with before treatment, and the BCVA at the last follow-up was significantly better than that at 1 month after operation (all at P<0.05).One month after operation and at the last follow-up, the BCVA of PPV+ anti-VEGF group was better than that of PPV group, showing statistically significant differences (both at P<0.05).Statistically significant differences were found in CRT between the two groups before and after treatment ( Fgroup=4.797, P=0.041; Ftime=295.764, P<0.001).One month after operation and at the last follow-up, the CRT of both groups was significantly improved in comparison with before treatment, and the CRT was significantly better at the last follow-up than 1 month after operation (both at P<0.05).The postoperative 1-month CRT of PPV+ anti-VEGF treatment group was lower than that of PPV group, with statistically significant difference ( P<0.05).No statistically significant difference was found in CRT between the two groups at the last follow-up ( P>0.05).Elevated intraocular pressure occurred in 2 eyes and rhegmatogenous retinal detachment in 1 eye in PPV group, accounting for 8.33% and 4.17%, respectively.Cataract aggravated in 2 eyes in PPV+ anti-VEGF group.The incidence of vitreous rebleeding in PPV group and PPV+ anti-VEGF group was 16.67%(4/24) and 8.33%(1/12), respectively, with no significant difference ( P=0.646).The incidence of macular scarring in PPV group and PPV+ anti-VEGF group was 4.17%(1/24) and 33.3%(4/12), respectively, showing a statistically significant difference ( P=0.030). Conclusions:Minimally invasive vitreous surgery is a safe and effective way to treat PCV combined with vitreous hemorrhage.It can improve vision, reduce CRT, and the effect is gradually enhanced in the short term.Intravitreal injection of anti-VEGF drugs can enhance the postoperative effect of PPV and present better vision and anatomical structure of retina.

A Study Of Clinical Profile And Visual Outcome In Patients Undergoing Vitrectomy For Vitreous Hemorrhage

Background:Aim&Objective:To study the epidemiology of vitreous hemorrhage in patients presenting without retinal detachment. To study various etiology of vitreous hemorrhage. To study visual outcome in patients with non resolving vitreous hemorrhage required vitrectomy surgery. To study prognostic factors (age, sex,andvitreous hemorrhage in diabetic patients, hypertensivepatients, ARMD, Ealesdiseases) affecting visual outcome in vitreous hemorrhage. Material And Methods:Study included34patients out of which 13 have diabetes, 6 have hypertension, 7have both diabetes and hypertension, 6have past history of tuberculosis and 2 have no systemic illne ss. Examination includedpreoperative and postoperative best corrected visual acuity, slit lamp examination, intraocular pressure, ultrasound B scan and dilated funduswith indirect ophthalmoscope. Result:Majority patients (38. 2%) were in the age group of 51-60 years with the mean age 51. 35 years. Males [73. 5%] had higher incidence of vitreous hemorrhage than females and Incidence of vitreous hemorrhage was higher in lower socio-economic group. Diabetes Mellitus andHypertension werethe most common co-morbidities with Proliferative diabetic retinopathy,Eales diseases and Branch Retinal vein occlusion are the important Risk factors for vitreous hemorrhage. Most common presenting symptom of vitreous hemorrhage is sudden loss of vision [52. 9%] followed by gradual loss of vision and blurring loss of vision. Patients who received pan retinal photocoagulation and Anti-vegf have better visual outcome post-operativel. Pan retinal photocoagulation, Epiretinal membrane, traction band,macular edema,andchoroidalneovascular membrane are the intraoperative findings noted intra-operatively. Preoperatively most of the cases of vitreous hemorrhage had visual acquity in the group of Perception of light and finger counting close to face. Post-operatively 15 patients have visual acuity in group of 6/18-6/9. Among them 8 were PDR,4 cases of Eales disease and 3 were BRVO cases. Visual acuity of 8 cases belongs to group of 6/60 –6/24 which include 5 PDR , 2 BRVO and 1 Ealesdisease. Post-operatively 7 patients developed complications. Raised IOP seen in 3 cases which includes 2 PDR cases and 1 Eales disease. Cataractous lens noticed in 2 PDR cases. Retinal detachment developed in 1 PDR case. Revitreous hemorrhage occurred in 1 Eales disease. 2 cases underwent re-surgery. Revitrectomy done in 1 case of Eales disease for re-vitreous hemorrhage. Re-vitrectomy with silicone oil insertion done in 1 PDR case for retinal detachment. Conclusion:Visual impairment due to Vitreous hemorrhagemay be prevented by early detection of cause by appropriate investigations and treatment.

Terson Syndrome: Assessment of 53 Patients with Subarachnoid Hemorrhage by a Ruptured Aneurysm

Objective Terson syndrome (TS), also known as vitreous hemorrhage, is reported in patients with subarachnoid hemorrhage caused by a ruptured aneurysm. This study aims to evaluate the presence of ocular hemorrhage in such patients, trying to identify those who could benefit from the specific treatment for visual deficit recovery. Methods Prospective study of 53 patients with spontaneous subarachnoid hemorrhage (SSAH) due to ruptured aneurysm. The patients were evaluated for vitreous hemorrhage through indirect fundoscopy with 6 to 12 months of follow-up. Results The ages of the patients ranged from 17 to 79 years-old (mean age, 45.9 11.7); 39 patients were female (73%) and 14 were male (27%). Six patients (11%) presented TS, and 83.3% had a transient loss of consciousness during ictus. Conclusions An ophthalmologic evaluation must be routinely performed in subarachnoid hemorrhage patients, especially in those with worse neurological grade. Moreover, prognosis was bad in TS patients.

Risk factors of postoperative vitreous hemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy / 中华实验眼科杂志

Objective:To investigate the risk factors of postoperative vitreous hemorrhage (PVH) after vitrectomy for proliferative diabetic retinopathy (PDR).Methods:A case-control study was conducted.A total of 1 848 consecutive PDR patients (1 848 eyes) with vitreous hemorrhage receiving first pars plana vitrectomy (PPV) in Tianjin Medical University Eye Hospital from June 2012 to May 2019 were enrolled.There were 979 males and 869 females, with the average age of (55.72±10.39) years.All of the enrolled eyes underwent standard three-channel PPV.The subjects were followed up for 6 to 24 months, with the mean follow-up of (379.34±231.28) days.The eyes were divided into PVH group and non-PVH group according to whether the PVH occurred or not.The PVH group were further divided into early PVH group and late PVH group according to the occurrence time of PVH.There were 170 (9.19%) of 1 848 eyes developed PVH after surgery, including 17.64%(30/170) of eyes with early PVH and 82.36% (140/170) of eyes with late PVH.The PVH occurred at 6 to 450 days after surgery.Baseline systemic parameters including sex, age, diabetes duration, preoperative glycosylated hemoglobin (HbA1c) level, and ocular parameters including whether or not performing panretinal photocoagnlation, whether or not receiving treatment of anti-vascular endothelial growth factor (VEGF) three days before operation, lens status, whether or not being combined with neovascularization of iris (NVI), as well as intraoperative ocular parameters including whether or not having neovascularization of disc (NVD) bleeding, whether or not being combined with cataract phacoemulsification, whether or not receiving postoperative anti-VEGF, were analyzed by multivariate logistic regression analysis to identify the risk factors of PVH after PPV in PDR patients with VH.This study adhered to the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2019KY[L]-09).Results:Multivariate logistic regression analysis revealed that age ( OR=0.940, P<0.01), preoperative high HbA1c level ( OR=1.878, P<0.01), combined with retinal vein occlusion (RVO) ( OR=8.310, P<0.01), diabetes diet to control blood glucose ( OR=3.030, P<0.01), diabetes duration ( OR=1.044, P<0.01), history of hypertension ( OR=1.802, P<0.01), nephropathy or cardiovascular or cerebrovascular diseases ( OR=18.377, P<0.01), preoperative NVI ( OR=7.488, P<0.01), not combined with phacoemulsification surgery ( OR=1.628, P=0.023), NVD bleeding ( OR=2.691, P<0.01), postoperative anti-VEGF treatment ( OR=0.181, P<0.01), postoperative air tamponade ( OR=1.901, P=0.024) were associated with PVH.There were no significant differences in baseline, ocular and intraoperative ocular parameters between early PVH and late PVH groups (all at P>0.05). Conclusions:Younger age, preoperative high HbA1c level, combined with RVO, diabetes diet to control diabetes, diabetes duration, history of hypertension, nephropathy or cardiovascular or cerebrovascular diseases, preoperative NVI, uncombined with cataract surgery, NVD bleeding, without postoperative intravitreal anti-VEGF injection, postoperative air tamponade are the potential risk factors of PVH after PPV for PDR patients with VH.

Evaluation of an aided diagnosis system for vitreous and retinal diseases by analyzing B-scan ultrasound images based on deep convolutional neural network / 中华实验眼科杂志

Objective:To explore the clinical value of a diagnostic system of ophthalmic B-scan ultrasound images based on deep convolutional neural network.Methods:A total of 3 600 ophthalmic B-scan ultrasound images of 1 278 patients with an average age of (49.32±7.69) years at the Eye Center of Renmin Hospital of Wuhan University from January 2018 to October 2020 were collected to build an image database.These B-scan images were labeled by three ophthalmologists.The database was divided into the training dataset of 2 812 images and the testing dataset of 788 images.The deep learning algorithm was used to build a diagnostic model, which can identify retinal detachment (RD), vitreous hemorrhage (VH) and posterior vitreous detachment (PVD), and the accuracy of the model was evaluated.Another 120 B-scan ultrasound images were collected for the human-computer comparison between the model and 3 senior ophthalmologists.Eight junior clinicians were selected to evaluate another 150 B-scan images with and without the assistance of the model, and the accuracy was analyzed to evaluate the effect of the model.This study adhered to the Declaration of Helsinki and the study protocol was approved by Renmin Hospital of Wuhan University (No.WDRY2020K-192).Results:The accuracy of the model for identifying normal fundus, RD, VH, PVD and other diseases were 0.954, 0.909, 0.881, 0.990 and 0.920, respectively.The accuracy of the model was similar to that of senior doctors, and the time the model used was almost half that of doctors.With the assistance of the model, the diagnostic accuracy of the 8 junior clinicians who participated in the training was significantly improved ( P<0.01). Conclusions:The accuracy of RD, VH and PVD identification of the intelligent evaluation system is good, and the system can improve the accuracy and efficiency of clinical examinations, and can better assist clinicians in clinical evaluation.

Analysis of the etiology and clinical characteristics in 1 413 cases of vitreous hemorrhage / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the etiology and clinical characteristics of patients with vitreous hemorrhage, and to provide a scientific evidence for the clinical diagnosis, treatment and prevention of vitreous hemorrhage. <p>METHODS: We has collected and investigate 1 413 cases(1 437 eyes)from March 2013 to November 2019 in the Second Hospital of Lanzhou University, which had treated with vitreous hemorrhage as initial diagnosis and under-went pars plana vitrectomy(PPV)treatment.<p>RESULTS: Among 1 437 eyes with vitreous hemorrhage, the major causes of vitreous hemorrhage were proliferative diabetic retinopathy(PDR)(37.72%), retinal vein occlusion(RVO)(27.00%), and ocular trauma(13.15%). Analysis of the etiology of the age group, among 308 eyes in the youth group, the main causes were ocular trauma(35.06%), PDR(22.73%)and Ealse disease(11.69%); 590 eyes in the middle-aged group. Based on the affected eyes, the main causes were PDR(45.08%), RVO(28.98%)and ocular trauma(10.00%); From 539 eyes in the elderly group, the main cause was PDR(38.22%)and RVO(34.69%)and retinal tears and retinal detachment(RT/RD)(7.05%). There were significant differences in the etiology of each age group(<i>P</i>=0.003). Gender etiology analysis showed that among 859 males with vitreous hemorrhage, the top 3 pathogenic factors were PDR(36.32%), RVO(21.65%)and ocular trauma(18.98%); among 578 female eyes, the main causes were respectively for PDR(39.79%), RVO(34.95%)and RT/RD(6.92%), there was a significant difference in etiology between males and females(<i>P</i><0.001).<p>CONCLUSION: PDR, RVO and ocular trauma were the main causes of vitreous hemorrhage in our study. Different age groups and genders caused different causes of vitreous hemorrhage. PDR and RVO were the primary causes of vitreous hemorrhage in middle-aged and elderly men and women; Ocular trauma was the primary cause of young male patients; PDR was the primary cause of young female patients.

Effect and safety of PPV assisted by intravitreal injection of Conbercept in the treatment of PDR combined with vitreous hemorrhage / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effect and safety of pars plana vitrectomy(PPV)assisted by intravitreal injection of conbercept in the treatment of proliferative diabetic retinopathy(PDR)combined with vitreous hemorrhage(VH).<p>METHODS: In the prospective randomized controlled study, patients with PDR and VH who were admitted to ophthalmology department of the hospital from February 2017 to September 2019 were enrolled as the research objects. They were randomly divided into observation group(39 cases, 39 eyes)and control group(38 cases, 38 eyes). Both groups underwent standard 27G PPV. The observation group underwent intravitreal injection of conbercept within 6-7d before surgery. The perioperative indexes were collected. The best corrected visual acuity(BCVA), intraocular pressure and central macular thickness(CMT)were followed up. The occurrence of surgical related complications was statistically analyzed.<p>RESULTS: Operation time(74.18±15.26 <i>vs </i>96.17±14.27min), number of bleeding eyes(8% <i>vs </i>37%), ratio of silicone oil filling(18% <i>vs </i>53%)and incidence of iatrogenic retinal breaks(15% <i>vs </i>47%)were lower in observation than control group(<i>P</i><0.05). BCVA at 1mo after surgery(0.33±0.10 <i>vs </i>0.60±0.21), 3mo after surgery(0.29±0.08 <i>vs </i>0.59±0.30)and 6mo after surgery(0.28±0.10 <i>vs </i>0.66±0.25)were significantly better in observation than control group(<i>P</i><0.05). CMT at 3mo after surgery(252.15±56.96 <i>vs </i>278.41±57.48μm)and 6mo after surgery(239.65±41.52 <i>vs </i>268.59±33.71μm)were significantly better in observation than control group(<i>P</i><0.05). During follow up, the incidence rates of VH in observation group and control group were 5% and 21%, respectively(<i>P</i><0.05). In control group, there were 3 eyes(8%)with tractional retinal detachment after surgery, while there was no tractional retinal detachment in observation group(<i>P</i>>0.05).<p>CONCLUSION: For patients with PDR and VH, intravitreal injection of conbercept before PPV can shorten operation time, reduce intraoperative blood loss and alleviate macular edema to obtain better visual acuity, with better curative effect and safety.