Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: ultrasound biomicroscopy findings

PURPOSE: To evaluate the frequency of fibrovascular ingrowth (FVIG) at sclerotomy sites in vitrectomized eyes of diabetic patients with postoperative vitreous hemorrhage referred for ultrasound biomicroscopy (UBM). DESIGN: Retrospective observational case series. PARTICIPANTS: Twenty-six eyes of 23 diabetic patients with recurrent, nonclearing postoperative vitreous hemorrhage subsequent to pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: Ultrasound biomicroscopy evaluation of all sclerotomy sites in patients referred for postoperative nonclearing or recurrent vitreous hemorrhage after PPV for PDR. Correlation with intraoperative findings was obtained in eyes undergoing revision of the vitrectomy. Eight eyes underwent repeat UBM after revision of the vitrectomy, and changes at previous sclerotomy sites were evaluated. MAIN OUTCOME MEASURES: Ultrasound biomicroscopy images at each sclerotomy site were classified into 3 categories: none (grade 0), minor (grade 1), and major (grade 2). The UBM characteristics of each category were defined by the examiner. Logistic regression analysis was performed to identify prognostic factors associated with development of FVIG in the study patients. RESULTS: Grade 1 or 2 FVIG was detected in 85% of cases, and grade 2 FVIG was identified in >/=1 sclerotomy site in 58% of cases. Grade 1 or 2 FVIG was detected in 56% of microvitrector sites, 41% of infusion sites, and 61% of light port sites. Ten patients underwent repeat vitrectomy because of recurrent nonclearing vitreous hemorrhage and UBM images showing FVIG. Inspection of the sclerotomy site confirmed the UBM findings in every case. Eight of these patients underwent follow-up UBM evaluation subsequent to the repeat vitrectomy. In 6 of the 8 patients, follow-up UBM showed no residual FVIG. CONCLUSIONS: Ultrasound biomicroscopy showed FVIG in a high proportion of eyes that experienced recurrent nonclearing vitreous hemorrhage after PPV for PDR. Ultrasound biomicroscopy is capable of detecting and characterizing FVIG at sclerotomy sites and may aid in reoperative planning.     

玻璃体切除术治疗糖尿病性视网膜病变玻璃体积血

目的：探讨玻璃体切除术治疗糖尿病性视网膜病变后单纯性玻璃体积血的临床疗效。方法：回顾性分析1998年8月－2000年10月我院采用玻璃体切除方法治疗糖尿病性视网膜病变单纯玻璃体积血患者40例（40眼），观察其临床疗效及术后并发症，随访期术后3－12月。结果：所有患者均顺利完成玻璃体积血切割术，术后3月视力≥0.6者10眼，视力0．1－0．6者20眼，视力数指－0．1者5眼，3眼术后发生视网膜脱离视力下降，2眼术后发生新生血管性青光眼，后行睫状体冷凝术视力丧失。结论：玻璃体切除术对于糖尿病性增生性视网膜病变所致的玻璃体积血性药物治疗长期不吸收的患者是安全有效的治疗方法，术后并发症少，手术效果好。     

玻璃体积血的超声诊断及临床疗效观察

目的：探讨玻璃体积血的声像图特征,以助于临床诊断治疗。

方法：回顾性分析62例各种原因导致玻璃体积血患者的临床资料。

结果：因外伤引起玻璃体积血者11例,占18%(11/62); 由于高度近视、高血压病、糖尿病等原因引起视网膜病变导致玻璃体积血者51例,占82%(51/62)。

结论：超声诊断玻璃体积血,图像比较清晰,对临床治疗的选择及预后监测起到了辅助作用,同时可以随访观察玻璃体积血治疗前后变化情况,对临床有一定的实用价值。     

Preoperative electroretinogram and postoperative visual outcome in patients with diabetic vitreous hemorrhage

PURPOSE: To determine whether the single-flash electroretinogram (ERG) can predict the postoperative outcome in diabetic cases where massive vitreous hemorrhage precludes fundus observation. METHODS: Eighty-five diabetic patients (105 eyes) who underwent vitrectomy due to dense vitreous hemorrhage were studied retrospectively. Eyes with postoperative complications were excluded. Preoperative ERGs (mixed cone-rod ERG with maximum flash intensity) were classified as: Group A, the b-wave/a-wave ratio (b/a ratio) was > or =1.0 and the oscillatory potentials (OPs) were clearly recordable (22 eyes); Group B, the b/a ratio was > or =1.0 and the OPs were markedly reduced (33 eyes); and Group C, the b/a ratio was <1.0 (50 eyes). RESULTS: The postoperative visual acuity in Group C (hand motion to 1.5) was significantly worse than in Group A (0.4-.2) (P<.01) or Group B (0.08-1.0) (P<.01). Thick preretinal membrane causing retinal traction around the optic disc was found intraoperatively in 1 eye (4.5%) in Group A, 9 eyes (27.3%) in Group B, and 28 eyes (56.0%) in Group C (P=.0132). CONCLUSION: Our findings suggested that the configuration of the single-flash ERG can provide important preoperative information for a functional prognosis following vitrectomy in diabetic patients with vitreous hemorrhage.     

Retinal tears after posterior vitreous detachment and vitreous hemorrhage in patients on systemic anticoagulants

Aims or Purpose

To determine the rate of retinal tears (RTs) after posterior vitreous detachment (PVD) and vitreous hemorrhage (VH) in patients on systemic anticoagulants.

Methods

In all, 260 eyes of 260 patients with an acute PVD and VH were followed for evidence of an RT or detachment. Patients were divided into those taking systemic anticoagulants and those not taking anticoagulants.

Results

A total of 137 patients (53%) were taking anticoagulants, 123 (47%) were not. Overall, 72% of patients not taking any anticoagulant had evidence of an RT, whereas 46% of patients taking an anticoagulant had an RT (P-value 0.0002). Also, 37% of patients not taking an anticoagulant had a retinal detachment (RD), whereas 23% of patients taking any anticoagulant had an RD (P-value 0.01).

Conclusions

In patients with an acute PVD and VH using anticoagulants, RTs and RDs were common. Anticoagulation status may be an important contributing factor in predicting the incidence of an RT or detachment.     

非外伤非糖尿病视网膜病变性玻璃体积血病因分析及手术疗效

目的 分析非外伤性非糖尿病视网膜病变性玻璃体积血的病因及手术疗效.方法 2006年3月至2009年7月期间住院手术的174例(176只眼)出现大量玻璃体积血的非糖尿病视网膜病变、非眼外伤患者的出血原因及手术情况进行了回顾性分析.结果 视网膜静脉阻塞(retinal vein occlusion,RVO)73只眼;视网膜静脉周围炎25只眼;视网膜裂孔或脱离(retinal hole/retinal detachment,(RH/RD)25只眼;渗出型年龄相关性黄斑变性(exudative age-related macular degeneration,EAMD)22只眼;息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)15只眼;共占90.9%,为非外伤性非糖尿病视网膜病变性玻璃体积血的主要原因.术后视力提高者达90%以上.结论 RVO,Eales病,视网膜裂孔,EAMD,PCV是非外伤非糖尿病视网膜病变性玻璃体积血的主要病因,玻璃体切割手术是治疗玻璃体积血的有效方法.

Abstract：

Objective To analyze the etiological factors in non-traumatic non-diabetec retinopathic vitreous hemorrhage and to investigate the clinical outcomes of vitrectomy in such patients.Methods The etiologic factor and recovery rate of visual functions in a total of 174 patients (176 eyes) undergoing vitrectomy with follow-up records from March 2006 to July 2009 in our department were analyzed retrospectively.Results Vitreous hemorrhage was found in 73 eyes of retinal vein occlusion (RVO),25 eyes of Eales' disease,25 eyes of retinal hole or retinal detachment (RH/RD),22 eyes ofexudative age-related macular degeneration (EAMD),and 15 eyes ofpolypoidal choroidal vasculopathy (PCV),amounting to 90.9% of total eyes.The visual improvement rate after vitrectomy was more than 90%.Conclusions RVO,Eales' disease,RH/RD,EAMD and PCV are main causes of non-traumatic non-diabetec retinopathic vitreous hemorrhage.Vitrectomy is an effective way for vitreous hemorrhage.     

Neovascular glaucoma and vitreous hemorrhage following cataract surgery in patients with diabetes mellitus

The potential complications of cataract surgery in the general population are well known. In addition, cataract extraction in the patient with diabetes mellitus is associated with other potential complications common to this disease: neovascular glaucoma and acceleration of proliferative diabetic retinopathy with or without vitreous hemorrhage. We analyzed the records of 154 patients with diabetes mellitus who had undergone standard intracapsular cataract extraction in one eye only with the other eye serving as the unoperated control eye. We were able to determine the status of the diabetic retinopathy before the operation and to note the development of vitreous hemorrhage and rubeosis iridis/neovascular glaucoma after the operation. If either event occurred within six weeks of the surgery, it was considered to be a complication of the cataract extraction. Intracapsular cataract extraction in this diabetic population, without regard of the preoperative status of the retinopathy, was associated with a statistically significant incidence of postoperative rubeosis iridis/neovascular glaucoma (7.8% vs 0%). In patients with preoperative active proliferative diabetic retinopathy, the risk of developing postoperative rubeosis iridis/neovascular glaucoma was even higher (40% vs 0%). There was also a statistically significant incidence of vitreous hemorrhage after surgery in eyes with no diabetic retinopathy or background diabetic retinopathy (6.5% vs 0%). In patients with active proliferative diabetic retinopathy, there was an increased incidence of vitreous hemorrhage after surgery (20% vs 6.5%), but this was not statistically significant due to the small number of patients studied. Possible explanations for these findings are explored and therapeutic and prophylactic measures recommended.     

Ultrasonic findings in the vitreous body in patients with acute anterior uveitis

The vitreous body of both the healthy and the affected eyes of 25 patients suffering from unilateral acute anterior uveitis was examined by ultrasound, and the results were compared with the optical observations made on the affected eye. In 14 eyes the optical examination of the vitreous body was impossible either due to exudation in the anterior chamber or to posterior synechias of the iris or to cataract. In 17 eyes the vitreous body was acoustically highly inhomogeneous, in three eyes slightly inhomogeneous and in five eyes no acoustic changes due to exudation were found. In cases of acute anterior uveitis, ultrasound examination often provides more information than optical examination by slit lamp. Ultrasound can also be useful in the treatment and follow-up of the disease.     

玻璃体切割手术治疗息肉状脉络膜血管病变引起的玻璃体积血的疗效观察

目的 观察玻璃体切割手术治疗息肉状脉络膜血管病变(PCV)引起的玻璃体积血的疗效.方法 伴玻璃体积血的PCV患者14例14只眼纳入研究.男性8例8只眼,女性6例6只眼.平均年龄(58.7±6.0)岁.均行常规眼科检查,以及A/B型超声、荧光索眼底血管造影、吲哚青绿血管造影等检查确诊.行常规玻璃体切割手术,手术中切除玻璃体积血,手术结束时行硅油或C3F8气体填充.手术后行光动力疗法(PDT)治疗8只眼.观察患眼视网膜复位情况、视力改善状况、病变稳定程度以及手术后并发症发生情况.结果 14只眼中,治愈6只眼,占42.9％;好转7只眼,占50.0％;无效或加重1只眼,占7.1％.1次手术后视网膜复位良好10只眼.视网膜复位不良4只眼.其中,再次注入硅油后视网膜复位1只眼;再次C3F8填充后视网膜复位1只眼;下方裂孔1只眼行巩膜外垫压手术后视网膜复位;未行特殊处理1只眼,硅油维持.最终视网膜复位13只眼,占92.9％,手术后1～7 d出现前房积血5只眼,经前房冲洗或药物治疗积血吸收,眼压稳定.视力提高2行以上者1只眼,1～2行者1只眼,不变10只眼,下降2只眼.行PDT治疗的8只眼中,异常血管消退5只眼,未消退3只眼.结论 对于伴玻璃体积血的PCV行玻璃体切割手术清除玻璃体积血,恢复屈光间质透明性,手术后联合PDT治疗,对稳定或提高视功能有一定的疗效.     

玻璃体切割术治疗视网膜静脉周围炎伴玻璃体出血

目的：评价玻璃体切割术治疗视网膜静脉周围炎伴玻璃体出血的疗效。方法：回顾性分析我院自1999年3月至2002年9月经玻璃体切割术治疗的视网膜静脉周围炎伴玻璃体出血患者13例18只眼的临床资料。结果：随访期为7个月～4年，平均23个月。18只眼视网膜均在位，16只眼(88.9％)视力较术前有不同程度的提高，其中视力≥0.3者11只眼(71％)，最好视力为1.0。术后玻璃体再出血2例，经药物治疗后出血吸收。无新生血管性青光眼发生。结论：玻璃体切割术是治疗视网膜静脉周围炎伴玻璃体出血的有效方法，可明显改善患者视力；结合术中及术后激光光凝治疗，可有效预防玻璃体再出血及新生血管性青光眼等并发症的发生。     

Syneresis and vitreous hemorrhage in pseudophacia

The eye of a 60-year-old man with a clinically very successful lens implant became available for pathological study after a very sudden and uncomplicated death about 6 months following cataract surgery. The following changes were found: slight non-granulomatous uveitis associated with foreign-body reaction to the lens implant and its supporting iris suture, absence of the anterior vitreous face, advanced syneresis of the central vitreous, vitreous hemorrhage with diffuse layering of erythrocytes on the inner aspect of the remaining vitreous crust, vitreous traction on peripheral and central retina with tenting of foveal internal limiting membrane, and some foveal edema without cystoid changes and without foveolar detachment. Knowledge of all these changes is important, because they were compatible with good visual function and caused no clinical problems. Supported by The Research to Prevent Blindness, Inc., New York, N.Y.     

超声血管造影在屈光间质混浊时对玻璃体积血和视网膜脱离的鉴别价值

目的　探讨超声血管造影在屈光间质混浊的情况下,对鉴别玻璃体积血和视网膜脱离的应用价值。方法　对纳入研究的对象术前均行超声血管造影检查,择期行玻璃体切割手术,将术中诊断结果与超声血管造影诊断结果进行对比,评估超声血管造影鉴别玻璃体积血和视网膜脱离的准确性。结果　术前超声血管造影诊断玻璃体积血１７眼,诊断视网膜脱离１４眼;术中诊断玻璃体积血１９眼,诊断视网膜脱离１２眼。超声血管造影对视网膜脱离的诊断敏感度为１００．００％,特异度为８９．４７％,诊断准确率为９３．５５％。对于玻璃体积血,其诊断敏感度为８９．４７％,特异度为１００．００％,诊断准确率为９３．５５％。结论　在屈光间质混浊的情况下,超声血管造影有助于鉴别玻璃体积血与视网膜脱离,可为临床的诊断与治疗提供可靠依据,具有重要的临床应用价值。     

Multiport-illumination-system-assisted phacoemulsification in eyes with dense vitreous hemorrhage during combined cataract and vitreous surgery

We describe the use of a multiport illumination system to enhance the red reflex during combined phacoemulsification and pars plana vitrectomy in 10 patients with cataract and vitreous hemorrhage. This method improves illumination and visualization of the lens structures and the instruments, which may reduce the risk of complication. To our knowledge, this approach has not been reported.     

Ultrasonic findings in the vitreous space in patients with detachment of the retina

Summary Ultrasonic observations were made of the vitreous body and the subretinal space of the sick eye and of the vitreous body of the other eye on 32 unselected subjects with idiopathic detachment of the retina. In almost all sick eyes a severe state of degeneration of the vitreous body was observed, and in all cases examined the subretinal space was acoustically heterogeneous.In the other eye degeneration of the vitreous body was often observed, although to a lesser degree than in the eye with retinal detachment. The ultrasonic examination of the vitreous body may yield information as to the disposition of the eye with regard to detachment of the retina.

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Zusammenfassung Bei 32 nicht ausgewählten Patienten, die an einseitiger idiopathischer Netzhautablösung litten, wurden mit Ultraschall der Glaskörper und Subretinalraum des Ablösungsauges sowie der Glaskörper des andern Auges untersucht. In allen an Netzhautablösung leidenden Augen wurde deutliche Degeneration, d.h. Synärese des Glaskörpers festgestellt, und der Subretinalraum war in allen untersuchten Fällen akustisch heterogen.In dem anderen Auge stieß man oft auf Glaskörperdegeneration, die jedoch geringer war als im Ablösungsauge. Die Ultraschalluntersuchung des Glaskörpers kann uns Kenntnis von der Disposition des Auges für Netzhautablösung vermitteln.

     

Intravitreous VEGF-A in eyes with massive vitreous hemorrhage

Purpose/background  

Although vascular endothelial growth factor (VEGF) is abundant in serum, the intraocular concentration of VEGF in eyes with massive vitreous hemorrhage (VH) is not well-known. The present study was conducted to elucidate the effects of a massive VH on intravitreous VEGF concentration.     

Trypan-blue- and endoillumination-assisted phacoemulsification in eyes with vitreous hemorrhage during combined cataract and vitreous surgery

PURPOSE: To study the safety and usefulness of trypan blue application and conventional endoillumination for enhancing visualization during phacoemulsification and foldable intraocular lens implantation in cases of cataract with vitreous hemorrhage. METHODS: Ten eyes of 10 patients with cataract and coexisting vitreous hemorrhage underwent combined trypan-blue- and endoillumination-assisted phacoemulsification and foldable intraocular lens implantation with vitrectomy. In a two-step surgery, after staining the anterior capsule with trypan blue, continuous circular capsulorhexis was performed; then, phacoemulsification was performed using conventional endoillumination. Specular microscopy was performed before and 3 months after surgery on eyes that underwent trypan-blue- and endoillumination-assisted phacoemulsification and on control eyes that underwent standard phacoemulsification to evaluate the toxic effect of trypan blue on corneal endothelial cells. RESULTS: Trypan blue application improved visualization of the anterior capsule, and a complete capsulorhexis could be performed in all eyes. In all 10 eyes, endoillumination was required to visualize the lens structure, and phacoemulsification could be accomplished. Specular microscopy revealed that there was no significant difference in the level of corneal endothelial cell loss between the trypan-blue- and endoillumination-assisted phacoemulsification group and the control group. CONCLUSION: The described double visualization technique may assist phacoemulsification in selected cases of cataract with vitreous hemorrhage.