Superoxide dismutase in the anterior chamber and the vitreous of diabetic patients.

Total superoxide dismutase (SOD) activity was examined in the anterior humor of 32 diabetic patients and 34 nondiabetic controls during cataract extraction. Median age (95% confidence interval) was 77.5 yr (73.3-81.0) and 79.3 yr (76.0-83.2), respectively. The SOD activity also was examined in posterior vitreous sampled peroperatively in 10 diabetics with proliferative retinopathy and post-mortem in seven diabetic patients and 35 nondiabetic controls. Ages were 57.2 yr (35.0-73.9), 74.4 yr (40.7-83.6), and 73.8 yr (65.0-80.2), respectively. In nondiabetic patients, the total SOD activity was much lower in the anterior chamber, 9.9 U/ml (8.1-12.6), than in the posterior vitreous, 106.3 U/ml (range 65.6-119.0), P < 0.001. We found no difference between the SOD levels in the anterior chamber of nondiabetic controls and diabetic patients, who had 9.6 U/ml (7.6-13.7). The SOD activity in posterior vitreous in diabetic patients sampled peroperatively, 23.9 U/ml (8.9-39.2), P < 0.0001, and post-mortem, 39.5 U/ml (6.5-214.2), P < 0.04, was significantly lower than in the controls sampled post-mortem, 106.3 U/ml (65.6-119.0). Low levels of SOD in the anterior chamber may be involved in cataract development, in diabetic patients and nondiabetic controls. That diabetics had decreased SOD activity in the posterior vitreous points to a possible role of SOD in the complex process of diabetic retinopathy development.     

Frequency and associations of a taut thickened posterior hyaloid, partial vitreomacular separation, and subretinal fluid in patients with diabetic macular edema

PURPOSE: To determine prospectively among patients with diabetic macular edema (DME) the frequency of a clinically evident taut thickened posterior hyaloid (TTPH), optical coherence tomography (OCT) signs suggestive of partial vitreomacular separation (PVMS), and OCT evidence of subretinal fluid (SRF) and to investigate for associations between these findings. METHODS: In a prospective case series, patients with DME despite previous laser treatment were examined for the presence of a TTPH. OCT was performed to investigate for PVMS and SRF. RESULTS: One hundred forty patients and eyes were included in the study. A TTPH was present in six patients (4%). PVMS was present in 14 (10%) of 140 patients with DME, of whom 5 also had a TTPH. SRF was present in 15 (11%) of 140 patients, of whom 4 had TTPH. OCT showed that 66% of patients with SRF and DME had neither a clinical TTPH nor partial posterior hyaloid separation. CONCLUSION: A TTPH was found in 4% of subjects with DME. Partial posterior hyaloid separation and SRF may be found in patients who do not have a TTPH. SRF in patients with DME may not be tractional.     

Cataract surgery in patients with diabetic retinopathy: Visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema

BACKGROUND: Compared to non-diabetic patients, outcome after cataract surgery was reported to be worse in diabetic patients--especially in those with diabetic retinopathy. This prospective study was planned to evaluate visual outcome, progression of diabetic retinopathy, and incidence of clinically significant macular oedema (CSME) in a homogenous group of patients with non-proliferative diabetic retinopathy (NPDR) without CSME at baseline 1 year after cataract surgery. METHODS: Over a period of 18 months, all consecutive patients with mild-to-moderate diabetic retinopathy who had cataract surgery with phacoemulsification and posterior chamber lens implantation were prospectively followed up. Outcomes were assessed 1 year postoperatively and included visual acuity (VA), progression of retinopathy, and incidence of CSME. Progression of retinopathy and incidence of CSME were compared to the non-operated fellow eyes. RESULTS: Of 50 patients included, 42 completed the 1-year follow-up. VA improved in 85% of patients, and was better than 0,5 in 71%. Progression of retinopathy occurred in 12% of eyes after cataract surgery and in 10.8% of non-operated fellow eyes. No patient developed proliferative diabetic retinopathy in the operated eye. CSME occurred in 13 operated eyes (31%), five of them with retinal ischemia, and in five non-operated eyes (13.5%). Patients with ischemic macular oedema had the worst prognosis regarding VA. CONCLUSION: Modern cataract surgery seems to have no influence on the progression of diabetic retinopathy. A visual improvement is achieved in the majority of patients with NPDR, but poorer visual outcome is observed in patients developing macular oedema.     

Management of post-vitrectomy persistent vitreous hemorrhage in pseudophakic eyes

PURPOSE: To prospectively assess the effect of neodymium:yttrium-aluminum-garnet peripheral capsulotomy on postvitrectomy hemorrhage in diabetic patients with a posterior chamber intraocular lens (IOL) implant and an intact posterior capsule. DESIGN: Interventional case series. METHODS: This is a prospective case series, clinical practice. PATIENTS: Five vitrectomized, diabetic, pseudophakic patients with persistent vitreous cavity hemorrhage remaining after vitrectomy were selected. They all had a posterior chamber IOL implant with an intact posterior capsule. Additionally, they had all undergone laser panretinal photocoagulation in the involved eye in the past for diabetic retinopathy. Neodymium:yttrium-aluminum-garnet laser capsulotomy outside the optic of the IOL was performed in victrectomized diabetic patients to treat the remaining vitreous cavity hemorrhage. Visual acuity, intraocular pressure (IOP), and fundus examination were measured and done immediately after the laser procedure, in 7 days and in approximately 3 months. RESULTS: The visual acuity was improved at the time of the first follow-up. However, a mild elevation of IOP was noticed in some patients, which was treated with topical dorzolamide. The final visual acuity was dramatically improved, to 20/30 or better, and the IOP was normalized without medication within a few weeks in all five cases. No neovascularization of the iris or elsewhere was noticed in any case. CONCLUSIONS: Neodymium:yttrium-aluminum-garnet laser peripheral capsulotomy appears to be a safe and effective management procedure in treating postvitrectomy hemorrhage in diabetic patients who have previously undergone cataract surgery with posterior chamber lens implant, intact posterior capsule, and extensive panretinal photocoagulation. The vitreous hemorrhage cleared completely in all five cases.     

Surgical results of combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation

PURPOSE: To evaluate the results and complications of combined pars plana vitrectomy (PPV), phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation. METHODS: A total of 117 eyes from 114 patients who had undergone PPV combined with PEA and IOL implantation were retrospectively analyzed. Combined surgery was performed for a wide variety of vitreoretinal diseases. Intraoperative and postoperative complications were also reviewed. RESULTS: The postoperative BCVA improved by 2 lines or more in 85 eyes (72.6%). Intraoperative complications consisted of retinal tears in 14 eyes (12.0%) and posterior capsular rupture in 2 eyes (1.7%). Iatrogenic retinal tears occurred more frequently in eyes with a macular hole than in eyes with any other disease (p=0.005, chi-square test). Postoperative complications consisted of posterior capsule opacification (PCO) (21 eyes), transient IOP elevation (29 eyes), vitreous hemorrhage (6 eyes), anterior chamber fibrin exudation (11 eyes), posterior iris synechia (8 eyes), neovascular glaucoma (1 eye), and recurrent retinal detachment (RD) (2 eyes). Fibrin exudation occurred more frequently in eyes with proliferative diabetic retinopathy (PDR) and RD than in eyes with any other disease (p=0.03, chi-square test). PCO occurred more frequently in eyes with PDR than in eyes with any other disease (p=0.03, chi-square test). CONCLUSIONS: The present study suggests that a high success rate can be achieved when recently improved PPV techniques are combined wi th PEA and IOL implantation. The complications that were observed following this combined treatment varied with respect to the vitreoretinal disease present prior to surgery.     

Surgical treatment for severe diabetic macular edema with massive hard exudates

PURPOSE: Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation. METHODS: The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded. RESULTS: All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye). CONCLUSION: Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema.     

Corneal endothelial cytoskeletal changes in F-actin with aging, diabetes, and after cytochalasin exposure.

We investigated the changes in endothelial cytoskeletal F-actin that occur with aging, diabetes, and exposure to cytochalasin D. Rabbit corneas, human donor corneas (with or without polymegethism), and corneas of diabetic individuals were studied. Endothelial F-actin was stained using nitrobenzoxadiazole-phallacidin. Results of these experiments demonstrated that F-actin of the rabbit and human corneal endothelium was arranged in linear circumferential strands that formed a hexagonal array. After in vitro perfusion of cytochalasin D to the corneal endothelium, the F-actin became randomly distributed throughout the cytoplasm, the hexagonal shape of the endothelial cell was disrupted, and endothelial permeability to carboxyfluorescein increased. Changes in F-actin were also observed in the endothelium of the human corneas with polymegethism, and in donor tissue having had previous posterior chamber intraocular lens implantation. The corneas of diabetic individuals also showed marked irregular F-actin fibers crossing the endothelial cell cytoplasm. These abnormal patterns of F-actin may contribute in part to the polymegethism observed in the corneal endothelial cells and may be the result of constant stress in cell volume regulation, particularly in the corneas of diabetic individuals.     

Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid

PURPOSE: To evaluate the role of vitrectomy in eyes with diffuse diabetic macular edema associated with a taut posterior hyaloid. METHODS: Records of 55 eyes of 50 patients with diabetic retinopathy and diffuse clinically significant diabetic macular edema who underwent vitrectomy with stripping of the premacular posterior hyaloid were reviewed. In all 55 eyes, diffuse diabetic macular edema was present on contact lens examination and confirmed with fluorescein angiography. On fundus examination, the premacular posterior hyaloid was attached and appeared taut. RESULTS: The mean preoperative best-corrected visual acuity was 20/160, and the mean final best-corrected visual acuity was 20/80 (P <.0001, Wilcoxon signed rank test), with 27 (49.1%) of the 55 eyes demonstrating improvement in best-corrected visual acuity of 2 or more lines. Fifty-two (94.5%) of the 55 vitrectomized eyes showed improvement in clinically significant macular edema and in 45 eyes (81.8%) the macular edema resolved completely during a mean period of 4.5 months (range, 1 to 13 months). Eyes with macular ischemia and preoperative best-corrected visual acuity of 20/200 or less tended to respond less favorably to vitrectomy than eyes lacking these characteristics. All eyes had at least 6 months of follow-up after surgery, with a mean follow-up of 23.2 months. CONCLUSION: In eyes with persistent diffuse diabetic macular edema with a taut premacular posterior hyaloid face unresponsive to laser therapy, vitrectomy with removal of the posterior hyaloid appears to be beneficial in some cases. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes.     

The role of the vitreous in diabetic macular edema

The authors assessed retrospectively clinical records of 76 patients (125 eyes) 60 years of age or older with diabetic retinopathy who had undergone a vitreous examination. The groups consisted of 105 eyes (63 patients) with macular edema and 20 eyes (13 patients) without macular edema. Vitreous studies were done using the El Bayadi-Kajiura lens to determine whether or not the posterior vitreous was attached to the retina in the macula. Twenty-one of 105 eyes (20.0%) in the edema group and 11 of 20 eyes (55.0%) in the no-edema group had a detached posterior vitreous. This difference was found to be statistically significant, indicating that diabetic cases without macular edema have a significantly higher rate of posterior vitreous detachment than those with macular edema. This study demonstrates that the vitreous may play a role in diabetic macular edema.     

Non-stereo photographic screening in long-term follow-up for detection of proliferative diabetic retinopathy.

The efficiency of two non-stereo photographs of the posterior pole as a screening device in long-term follow-up for the detection of proliferative diabetic retinopathy was evaluated in a clinical setting among 1341 diabetic hospital patients. False positive findings occurred in 0.4% (6/1341). Severe irreversible sight-threatening complications from undetected proliferative diabetic retinopathy, such as retinal traction detachment or secondary glaucoma, never occurred. Vitreous haemorrhages due to missed new vessels in the photographic area occurred in only 2 out of 3020 photographic reading sessions over a 5.5 year period. Evaluation of the nature, localization and magnitude of new vessels showed that optic disc new vessels were generally over-diagnosed in younger patients and missed in patients aged 45 years or older. New vessels elsewhere were more frequently misdiagnosed in patients older than 50 years. New vessels were most commonly found on the temporal arcades (48%) of the eyes and nasal to the optic disc (42%) but were significantly rare beyond the posterior pole (13%) (P less than 0.001). Patients younger than 60 years had significantly more lesions (P less than 0.001) and these lesions tended to be bilateral. Two non-stereo photographs of the posterior pole is a safe and efficient alternative method to conventional survey for proliferative diabetic retinopathy. New vessels are significantly most common in the posterior pole and complications from new vessels occurring exclusively outside the posterior pole can be disregarded. Bilateral neovascularization should be anticipated in patients under 60 years.     

糖尿病白内障超声乳化人工晶状体植入疗效观察

目的：探讨糖尿病患者白内障超声乳化摘除联合囊袋内人工晶状体植入术后的疗效及并发症。方法：对６１例（８１眼）糖尿病白内障患者施行超声乳化摘除联合囊袋内人工晶状体植入术治疗。结果：术后视力≥０．５者占８５．１９％,视力≥０．３者占８８．８９％,并发症主要包括;晶状体后囊破裂５眼,占６％,角膜纹状混浊１６眼,占１９％,前房纤维素性渗出６眼,占７％,后囊混浊１０眼,占１２％,糖尿病视网膜病变１３眼,占１６     

Intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema

PURPOSE: To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. METHODS: This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. RESULTS: Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. CONCLUSIONS: The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.     

Epiretinal membranes and incomplete posterior vitreous detachment in diabetic macular edema, detected by spectral-domain optical coherence tomography

PURPOSE. To present the vitreoretinal interface in diabetic macular edema (DME) associated with both epiretinal membrane (ERM) and incomplete posterior vitreous detachment (PVD), as detected by spectral-domain optical coherence tomography (SD-OCT). METHODS. In a retrospective study, findings were analyzed in one eye in consecutive patients. Excluded were eyes that had undergone vitreoretinal intervention or that had complete PVD or complete vitreous attachment. RESULTS. Of 44 eyes with DME and ERM, incomplete PVD was apparent in 23 (52.2%) eyes. A hyperreflective unified ERM/posterior vitreous cortex (PViC) membrane, or EVi membrane, was apparent in various sizes in 20 (87.0%) of the 23 eyes. This unified membrane (n = 20) was associated with vitreopapillary adherence in 19 (82.6%) of 23 eyes. Two major OCT presentations (n = 23) were encountered: incomplete vitreopapillary detachment (n = 11; 25% of 44), with attachment to the macular ERM, and posterior vitreous detachment from the macula, associated with vitreopapillary adhesion (n = 10; 22.7%), in four different manifestations. In the remaining two eyes, there was no association between the ERM and the PViC. CONCLUSIONS. In eyes with DME, ERM, and incomplete PVD, the posterior cortical vitreous and ERM appeared as one united EVi membrane in various lengths in most eyes, typically associated with vitreopapillary adhesion. These findings may have clinical importance in the context of epimacular membrane characteristics and its removal in DME.     

The influence of spontaneous posterior vitreous detachment in resolution of diabetic macular edema in NIDDM

PURPOSE: To establish the influence of posterior vitreous detachment on development and resolution of diabetic macular edema in NIDDM. To asses the posterior vitreous detachment role in argon laser treatment of diabetic macular edema. MATERIAL AND METHODS: Retrospective study. RESULTS: 68 eyes of 36 patients were involved into the study, 52 eyes (76.5%) with macular edema and 16 eyes (23.5%) without macular edema. Posterior vitreous detachment (PVD) was present in 62.5% of cases without macular edema, and only 30.77% of cases had macular edema. Laser treatment applied in accordance to general standards cased resolution of macular edema in all cases with posterior vitreous detachment. In group with no spontaneous posterior vitreous detachment, macular edema resolved only in 19.23% of cases. CONCLUSIONS: Diabetic macular edema is less common in eyes with spontaneous posterior vitreous detachment. This observation shows, that not only vascular factor but also vitreo-macular tractions are responsible for macular pathology in diabetic macular edema. The efficacy of standard argon laser treatment depends also on vitreo-macular relation--presence of PVD, and is more sufficient in eyes with posterior vitreous detachment.     

Importance of the vitreous in young diabetics with macular edema

The authors assessed retrospectively the clinical records of 80 patients (137 eyes) with diabetic retinopathy who were 50 years of age or younger and who had undergone a vitreous examination. The group comprised 53 patients (91 eyes) with macular edema and 27 patients (46 eyes) without macular edema. Vitreous studies using the El Bayadi-Kajiura lens determined whether the posterior vitreous was attached to the retina in the macula. Forty (42.1%) of 91 eyes in the edema group and none (0%) of the 46 eyes in the nonedema group had a detached posterior vitreous. This difference was statistically significant, indicating that young diabetic patients with macular edema have a significantly higher rate of posterior vitreous detachment than those without macular edema.     

Vitreous opacification after neodymium:YAG posterior capsulotomy.

PURPOSE: To describe the clinical picture in eyes that developed vitreous opacification behind the intraocular lens (IOL) after neodymium:YAG (Nd:YAG) laser posterior capsulotomy and determine whether this type of opacification tends to occur in patients with diabetes. SETTING: Shinjo Eye Clinic, Miyazaki, Japan. METHODS: The clinical course in 728 eyes that had Nd:YAG posterior capsulotomy was reviewed. RESULTS: After Nd:YAG posterior capsulotomy, opacification developed in the vitreous in contact with the IOL in 9 eyes (1.2%). All occurred in diabetic patients, and the vitreous opacification developed within 1 month after the capsulotomy. A vitrectomy was performed in 8 eyes and in 1, the opacification spontaneously absorbed. Vitreous opacification occurred in 8.9% of 101 eyes of diabetic patients, and the prevalence in diabetic eyes was significantly higher than in nondiabetic eyes (P < .0001). Nine of the diabetic eyes were opaque and 92 nonopaque. In the opaque eyes, the prevalence of panretinal photocoagulation was higher than in the nonopaque eyes (P = .013), and hemoglobin Alc (P = .030) was higher; the interval between cataract surgery and Nd:YAG capsulotomy was shorter (P = .047) and the final visual acuity, lower (P = .045). CONCLUSION: The prevalence of vitreous opacification after Nd:YAG laser posterior capsulotomy was significantly higher in diabetic than in nondiabetic eyes. Viterectomy was effective for this type of opacification.     

Ocular blood flow velocities in patients with proliferative diabetic retinopathy and healthy volunteers: a prospective study.

BACKGROUND--Diabetes affects the vascular ocular circulation. Colour Doppler imaging allows for simultaneous two dimensional anatomical imaging and Doppler evaluation of blood flow velocity; with this technique ocular blood flow velocity can be evaluated in normal and diabetic patients. METHODS--A prospective study compared blood flow velocity in ocular vessels (ophthalmic artery, posterior ciliary arteries, central retinal vessels, and vortex veins) of 25 patients with proliferative diabetic retinopathy and 30 age matched normal subjects using a colour Doppler imaging unit (Toshiba Sonolayer SSA-270 A with a 5.0 MHz PLF-503 ST phased array scanning head). RESULTS--The diabetic patients had lower blood velocities than the volunteers. There were significant differences in ophthalmic artery; systolic (p < 0.01), diastolic (p < 0.001), mean velocity (p < 0.05), and central retinal artery; systolic (p < 0.001), diastolic (p < 0.001), mean velocity (p < 0.05). No significant correlations were found between age and blood velocities. CONCLUSION--Ocular blood flow velocity was decreased in diabetic patients with proliferative diabetic retinopathy.     

Posterior chamber intraocular lens implantation in eyes with inactive and active proliferative diabetic retinopathy

We reviewed the records of 2,100 consecutive eyes that had undergone extracapsular cataract extraction with intraocular lens implantation between January 1981 and December 1989. Of these eyes, 21 had inactive and four had active proliferative diabetic retinopathy at the time of cataract extraction. Twenty-one eyes with inactive proliferative diabetic retinopathy received extracapsular cataract extraction with posterior chamber intraocular lens implantation, and four eyes with active proliferative diabetic retinopathy had both extracapsular cataract extraction with posterior chamber intraocular lens implantation and pars plana vitrectomy with endophotocoagulation. The mean follow-up period was 27 months. Final visual acuity was 20/40 or better in 12 of 25 eyes (48%). Of 25 eyes, five (20%) showed progression of the retinopathy after the operation, and two (8%) developed macular edema. Extracapsular cataract extraction and posterior chamber intraocular lens implantation was well tolerated in most eyes.     

Vitrectomy with peeling retinal limiting membrane (ILM) in eyes with diabetic macular edema

PURPOSE: To evaluate the efficacy of pars plana vitrectomy with retinal internal limiting membrane (ILM) peeling in eyes with diabetic macular edema. MATERIAL AND METHODS: Twenty five eyes of 25 patients with diabetic macular edema. All eyes underwent a pars plana vitrectomy including separation of the posterior hyaloid, ILM peeling and air endotamponde. Preoperatively visual acuity (VA), funduscopic examination and the presence or absence of posterior vitreous detachment, were evaluated. Fluorescein angiography was performed in all patients prior to surgery. Eyes with cystoid macular edema or macular ischaemia were excluded. Postoperative VA, anatomic results, and complications were recorded. The follow-up was 7 to 27 months (mean 17). RESULTS: Intraoperatively, thick posterior hyaloid was found to be attached to the posterior pole in 20 cases. The mean postoperative VA (0.2) was significantly better than the preoperative VA (0.08) (p = 0.0001). VA improved postoperatively in 21 eyes (84%), at least two lines on the Snellen chart in 8 eyes (32%). It remained unchanged in 4 eyes (16%). Confluent hard exudates in fovea were present significantly more frequently in eyes without VA improvement (p = 0.004). The postoperative VA was better in eyes that had not undergone photocoagulation (improvement by 0.14 line) than in others (improvement by 0.11 line) but the difference was non-significant. Reduction of macular exudates was noted in every case in the follow-up over 6 months. Postoperative complication included retinal detachment were treated by re-vitrectomy with oil endotamponade. Cataract has been noted in six eyes. CONCLUSIONS: Vitrectomy including removal of ILM in diabetic macular edema, leads to improvement of visual acuity and long-term stabilization of visual function.     

The predictive value of echography in diabetic vitreous hemorrhage

PURPOSE: To identify echographic signs that are predictive for the prognosis of diabetic vitreous hemorrhage (VH). METHODS: Sixty eyes of 58 diabetic patients with VH were divided into two groups: group I contained 32 eyes with nonclearing diabetic VH which underwent pars plana vitrectomies. Group II contained 28 eyes which cleared spontaneously with time. The echographic signs were classified according to blood density, blood location and to the presence of vitreoretinal traction. RESULTS: The two groups showed statistically significant differences (P < 0.01) in the frequencies of the same echographic signs. In group I, a high or moderate density of blood in the vitreous cavity (71.5% of eyes), partial posterior vitreous detachment with one or more vitreoretinal or papillary traction sites (67.8%) and blood located in the vitreous gel (62.5%) were the main echographic signs associated with nonclearing diabetic VH. In group II, a low density of blood in the vitreous cavity (75%), total posterior vitreous detachment without a vitreoretinal or papillary traction site (68.8%) and blood in the subvitreal space (46.5%) were the main echographic signs associated with a diabetic VH that will clear with time. The presence of blood in both the vitreous gel and in the subvitreal space occurred at the same frequency (near 28%). CONCLUSIONS: Ultrasonographic examination of a diabetic VH can be predictive for the ultimate prognosis of the intraocular blood. The echographic signs found to be associated with spontaneous clearing of the hemorrhage are a low density of hemorrhage, complete vitreous detachment and blood in the subvitreal space.