Causes and treatment of vitreous hemorrhage

Vitreous hemorrhage is common, with varied clinical manifestations and causes. The most common causes include proliferative diabetic retinopathy, vitreous detachment with or without retinal breaks, and trauma. Less common causes include vascular occlusive disease, retinal arterial macroaneurysm, hemoglobinopathies, age-related macular degeneration, intraocular tumors, and others. The natural history depends on the underlying cause, and is generally more favorable in eyes without underlying disease. Treatment is directed at the underlying cause, such as laser photo-coagulation for proliferative diabetic retinopathy or for retinal breaks. Occasionally, hemorrhage does not resolve spontaneously and vitrectomy surgery is necessary and beneficial. New strategies for the treatment of vitreous hemorrhage, such as pharmacologic vitreous liquefaction, may be important in the future.     

Lens-sparing vitreous surgery for infantile amblyogenic vitreous hemorrhage

PURPOSE: To report on a series of infants with amblyogenic vitreous and/or subinternal limiting membrane hemorrhage managed by lens-sparing vitrectomy. DESIGN: Retrospective case series studying retinal attachment status and visual acuity. RESULTS: Eleven eyes sustained vitreous hemorrhage as a consequence of shaken baby syndrome, 1 due to hyaloidal canal hemorrhage extending into the vitreous, 1 due to Terson syndrome, 1 due to birth trauma, and 2 due to a presumed coagulation disorder. Age of the patients at the time of surgery ranged from 2 to 23 months (age adjusted for prematurity). Follow-up ranged from 7 to 81 months (mean, 28 months). Ten eyes had visual improvement. Two infants with shaken baby syndrome had bilateral nonrecordable flash visual evoked potential before surgery; one eye of one infant had a better than expected visual outcome after surgery. One eye sustained a retinal tear without detachment. One eye in an infant with severe shaken baby syndrome and traumatic retinopathy developed a total rhegmatogenous retinal detachment with proliferative vitreoretinopathy. CONCLUSIONS: Infantile amblyogenic vitreous hemorrhage may be effectively managed by lens-sparing vitreous surgery. Visual outcome of shaken baby syndrome may be limited as a consequence of structural damage to the retina, optic nerve, or posterior visual pathways.     

玻璃体积血的形态结构与玻璃体后脱离的图像特征

目的探讨玻璃体积血的形态结构和治疗特点.方法对74例(79只眼)增生性糖尿病视网膜病变、视网膜血管炎、视网膜静脉阻塞所致玻璃体积血的临床资料进行比较分析.术前超声检查、术中手术显微镜观察患者的玻璃体形态特点,分析玻璃体与视网膜的关系.结果所有患者均有不同程度的玻璃体后脱离,根据图像的形态特征可归纳为完全后脱离和部分后脱离两种.部分后脱离又分为"V"型、"L"型及后部玻璃体劈裂型,劈裂型多见于视网膜缺血性疾病的增生期.结论了解和掌握玻璃体后脱离及玻璃体劈裂的形态特点,可提高手术治疗的成功率并改善其预后.     

Exotropia secondary to vitreous hemorrhage

Background: Diplopia after cataract surgery has been reported by several authors, but diplopia after recovery from vitreous hemorrhage (VH) has not been described. Methods: We examined eight patients with manifest exotropia and binocular diplopia after recovery from dense VH by vitreous surgery. VH was bilateral in three patients and unilateral in five, and lasted for an average of 7.7 years. Results: Visual acuity before vitrectomy ranged from 20/200 to light perception; that after vitrectomy ranged from 20/20 to 20/60. Exotropia was present in all patients after vitrectomy. Additionally, seven out of eight patients had vertical strabismus with an average deviation of 6 prism diopters (). Fusion was confirmed in four patients with an average amplitude of 13 . Four patients underwent horizontal strabismus surgery. Fusion was present in two before strabismus surgery and in all four after surgery; however, unstable diplopia persisted in three of the four after surgery. Conclusion: Diplopia after vitrectomy for longstanding VH may occur due to fusion impairment comparable to that occasionally seen after surgery for traumatic cataract.     

Myopia induced by vitreous hemorrhage

Six of 11 children developed myopia in one eye after vitreous hemorrhage. None had retinopathy of prematurity, glaucoma, aphakia, or scleral buckling. In seven children developing vitreous hemorrhage before 1 year of age, six exhibited a myopic anisometropia in the affected eye of 1.37 to 12.00 diopters (mean, -4.7 diopters; S.D., 4.0). The degree of myopia correlated with the age of onset and duration of media opacification. In the child without myopia, the hemorrhage did not obscure the posterior pole. None of the four children whose hemorrhage occurred after 2 1/2 years of age showed myopic anisometropia (mean, +0.16 diopters; S.D., 0.24). We conclude that vitreous hemorrhage occurring in infancy is strongly associated with the development of myopia in the affected eye.     

Vitrectomy for diabetic vitreous hemorrhage

The surgical results for 248 eyes that underwent vitrectomy for diabetic vitreous hemorrhage showed that at the final examinations, 194 (78%) had improved visual acuities, 43 (17%) had worse visual acuities, and 11 (4%) were unchanged. Of the 248 eyes, 60 (24%) had final visual acuities of 20/40 or better, 128 eyes (52%) had final visual acuities of 20/50 to 20/800, and 60 (24%) had final visual acuities worse than 20/800. Eyes with preoperative iris neovascularization had a substantially worse visual result than eyes without this complication. Eyes in which the lenses were removed during vitrectomy also had worse visual results, primarily because they had a higher cumulative incidence of postoperative iris neovascularization and neovascular glaucoma.     

Vitrectomy for nondiabetic vitreous hemorrhage

In a group of 94 eyes with nondiabetic vitreous hemorrhage that underwent pars plana vitrectomy between March 1974 and September 1982, the causes of the hemorrhages were retinal branch vein obstruction (36 eyes), blunt trauma (11 eyes), cataract extraction (ten eyes), subretinal neovascularization (nine eyes), Eales' disease (eight eyes), Terson's syndrome (four eyes), and idiopathic (five eyes) and miscellaneous (11 eyes) conditions. Vision was improved postoperatively in 88 of the 94 eyes, including all of those that underwent blunt trauma or cataract extraction, those with Eales' disease and Terson's syndrome, and those in the idiopathic and miscellaneous groups. Final visual acuities, which depended primarily on the underlying condition and its effect on the macula, were 20/20 or better in ten eyes, 20/25 to 20/40 in 37 eyes, 20/50 to 20/200 in 26 eyes, 20/300 to 20/400 in 11 eyes, 9/200 to 5/200 in three eyes, and hand movements or light perception in seven eyes. Retinal tears, the most common surgical complication, occurred in 18 eyes. The incidence of anterior retinal tears was reduced from 11% (11 of 38 eyes) to 4% (two of 56 eyes) after we began using a vitrectomy probe with a smaller diameter. Some postoperative lens opacification occurred in 16 of 50 phakic eyes, and the incidence of later lens opacification increased as the follow-up lengthened.     

玻璃体积血的分期治疗

目的:观察分期治疗玻璃体积血的疗效。方法:将玻璃体积血的病程分早、中、晚3个时期,早期急则治其标,以凉血止血为主;中期以活血化瘀为主;晚期以益气、活血、软坚散结为主。14d为一个疗程,共治疗2个疗程。主要观察视力,玻璃体积血的吸收情况。结果:分期治疗玻璃体积血总有效率88.5%。结论:分期治疗玻璃体积血疗效显著。     

玻璃体切割治疗玻璃体积血的临床疗效观察

目的:探讨玻璃体切割治疗玻璃体积血的临床疗效。方法:对72例75眼玻璃体积血患者采用玻璃体切割手术治疗,术中根据具体病情联合单纯白内障摘除或白内障摘除联合人工晶状体植入术、眼内异物取出、膜剥离、水下透热、眼内光凝或/和巩膜外冷凝及眼内注气或硅油充填。结果:选取75眼中外伤性玻璃体积血(穿孔性眼外伤19眼,眼球钝挫伤8眼)27眼,视网膜静脉阻塞15眼,增殖期糖尿病视网膜病变12眼,Eales病9眼,视网膜裂孔合并玻璃体积血9眼,年龄相关性黄斑病变3眼。术后随访6～48(平均18±5.6)mo,75眼中72眼视力有不同程度的提高,>0.05者65眼(87%),>0.2者54眼(72%),>0.5者23眼(31%),术后视力没有提高3眼(4%),术后视力与术前相比差异具有统计学意义(P<0.05)。结论:严重的眼外伤合并玻璃体积血、大量玻璃体积血药物治疗不吸收,反复发生的玻璃体积血和B超检查发现视网膜脱离者应及时行玻璃体切割术以改善和保护视功能。     

玻璃体积血合并内界膜下出血的手术治疗

目的 探讨眼纯挫伤和颅脑外伤合并内界膜下出血的玻璃体积血的临床特点及处理方法.方法 我们收治的合并内界膜下出血的玻璃体积血患者9例14眼,其中眼部纯挫伤3例3眼,Terson综合征5例11眼.手术采用轴性玻璃体切割联合内界膜剥离或切除清除内界膜下积血.结果 术前视力均为手动～数指/眼前,术后视力0.5～1.0.手术对于出血病程较短患者的视力提高效果较好,最佳视力为1.0;而病程较长者的最佳视力0.6.对于内界膜术中剥离时,根据病程的长短,采取剥离和切除的方法;对于陈旧性出血,术中不能完全清除,术后5～10 d内自行吸收.随访6个月～3 a.均保持较为稳定的视力.结论 2种情况均可以造成内界膜下出血及玻璃体积血,手术量可以根据玻璃体积血的形态做轴性玻璃体切割,内界膜切除不是目的,关键在于吸除其下的积血.     

玻璃体切割术治疗非糖尿病性玻璃体出血

本文报告50例53眼非糖尿病性玻璃体出血的玻璃体切割术,术后视力进步的39眼(73.6%),其中达到0.05以上的27眼(50%).术后视力与病因及黄斑功能有关,其中以挫伤性玻璃体出血效果最好,全部视力有进步.其次为视网膜静脉周围炎,77%视力有进步.术后并发症中以玻璃体再出血及继发性青光眼多见,继发性青光眼中以血影细胞性青光眼为多(4/6).本文对手术时机,切割程度及血影细胞性青光眼进行了讨论.     

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.