Intravitreal bevacizumab injection for recurrent vitreous haemorrhage after diabetic vitrectomy

Purpose: To evaluate the efficacy of intravitreal bevacizumab in treating recurrent vitreous haemorrhage (VH) after diabetic vitrectomy. Methods: Consecutive patients with postoperative recurrent VH ≥ 2 weeks after primary diabetic vitrectomy were treated with intravitreal bevacizumab. Repeated injection was given after 2–3 weeks in case of no obvious blood reabsorption (study group). Consecutive patients with the same complication but without bevacizumab injection served as the control group. Vitreous surgeries in both groups were indicated if no clinical improvement was noted 10–12 weeks after the initial bleeding. Vitreous clear‐up time (VCT), vitreous surgeries and rebleeding rates, and visual acuity changes were compared between both groups. Results: The study group had 20 eyes (20 patients) and the control group had 18 eyes (18 patients). Postoperative VH occurred between 1 and 25 months and between 1 and 18 months, respectively. In the study group, VCT after the first recurrent VH was 6.5 ± 1.5 weeks with 2.2 ± 0.8 injections. Nine cases had ≥ one episode of VH, but no surgery was needed. In the control group, 13 eyes had spontaneous re‐absorption (in 6.4 ± 1.3 weeks); five eyes underwent surgeries; three of the 13 eyes eventually had surgeries after further recurrent VH. The rate of vitreous surgery in the two groups was 0/20 and 8/18 (p = 0.01). The total number of rebleeding was 30 in the study group and 27 in the control group (p = 0.69). Conclusion: Intravitreal bevacizumab treatment may reduce the need of revitrectomy for recurrent vitreous haemorrhage after diabetic vitrectomy.     

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.     

Epithelial ingrowth following surgery of recurrent pterygium

Epithelial ingrowth is a rare but devastating condition of the eye, known to complicate incisional ocular procedures. We report a case of secondary glaucoma due to epithelial ingrowth following limbal conjunctival autograft in a case of recurrent pterygium. To prevent such devastating conditions from occurring dissection of recurrent pterygium demands special care to avoid anterior chamber penetration. Institution to which the work should be attributed: MR Bangoor Hospital.     

Xenon-arc endophotocoagulation during vitrectomy for diabetic vitreous haemorrhage

The value of scatter xenon-arc endophotocoagulation in stabilising eyes with respect to post-operative rubeosis iridis and vitreous haemorrhage is demonstrated in a consecutive series of 100 vitrectomies undertaken for diabetic vitreous haemorrhage. Seventy eyes ultimately achieved 6/36 or better vision. Endophotocoagulation of untreated ischaemic retina is recommended in eyes undergoing vitrectomy for diabetic vitreous haemorrhage.     

Intravitreal ranibizumab versus vitrectomy for recurrent vitreous haemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy: a prospective study

International Ophthalmology - To compare prospectively intravitreal ranibizumab treatment and pars plana vitrectomy (PPV) in patients with recurrent vitreous haemorrhage (VH) due to proliferative...     

Abortive neovascular outgrowths discovered during vitrectomy for diabetic vitreous haemorrhage

Abortive neovascular outgrowths from the retina were identified in 13 out of 34 eyes (38%) undergoing vitrectomy for diabetic vitreous haemorrhage. Postoperatively, fluorescein angiography of the lesions demonstrated a characteristic smoke-stack pattern of dye leakage. Each outgrowth appears to represent a focal variant of preretinal neovascularisation complicating retinal capillary non-perfusion and inner retinal ischaemia, their distinctive features being determined primarily by the absence of a cortical vitreous scaffold on the retinal surface at the time of vasoproliferation.     

Fibrovascular ingrowth into hydroxyapatite and porous polyethylene orbital implants wrapped with acellular dermis

PURPOSE: Acellular dermis is a frequently used wrapping material for hydroxyapatite (HA) and porous polyethylene (PP) orbital implants. In an animal model, we determined by histology the extent of fibrovascular ingrowth within orbital implants wrapped in acellular dermis at 6 and 12 weeks after surgery. METHODS: Four Yucatan minipigs were used for the study. Two minipigs had HA implants and two had PP implants. Implants were harvested at 6 or 12 weeks after surgery and were examined histologically for fibrovascular ingrowth. RESULTS: There was complete fibrovascularization of HA implants harvested at both 6 and 12 weeks after surgery. The PP implant harvested at 6 weeks had incomplete fibrovascularization, whereas the PP implant harvested at 12 weeks had complete fibrovascular ingrowth. There was no histologic evidence of inflammation seen in any of the orbital implants. On gross and histologic examination, the wraps were found to persist on the surface of all orbital implants, with little histologic evidence of inflammation localized to the acellular dermis. CONCLUSIONS: Acellular dermis wraps support fibrovascularization of both HA and PP orbital implants. Additionally, acellular dermis does not incite significant inflammation in association with HA and PP orbital implants and can persist in situ for at least 12 weeks after surgery.     

Fibrovascular ingrowth as a cause of Ahmed glaucoma valve failure in children

PURPOSE: The purpose of this study is to document the presence of fibrovascular ingrowth into the Ahmed glaucoma valve (AGV) as a cause of AGV failure in the pediatric population. DESIGN: Retrospective case series. METHODS: Retrospective study of six children with histologically documented fibrovascular ingrowth of their AGV, with review of relevant demographic, clinical, and surgical factors. RESULTS: Six patients, two males and four females, with a mean age at AGV placement of 27.5 months (range 1 to 122) were identified with AGV failure, AGV removal, and subsequent histology documenting fibrovascular ingrowth into the valve chamber. Etiology of glaucoma included: trauma, aphakia, angle-closure, aniridia, and infantile. Mean time from AGV implantation to explantation was 23 months (range 6 to 65). Mean intraocular pressure at AGV explantation was 35 mm Hg (range 27 to 48). CONCLUSIONS: Fibrovascular ingrowth of both the pediatric and adult size AGV occurs in children and should be considered in the presence of AGV failure.     

Pathologic study following vitrectomy for proliferative diabetic retinopathy

This article details the pathologic findings in eyes removed postmortem from a diabetic man with proliferative retinopathy, vitreous hemorrhage, and tractional retinal detachment. Several years before death, to control hemorrhage from extraretinal vasoproliferative lesions, one eye only was treated with argon laser panretinal photocoagulation. Eight months before death the treated eye also was operated for tractional retinal detachment with current vitrectomy methods: membranotomy, partial peeling, and segmentation of preretinal membranes. Despite their atropic clinical appearance, the extraretinal lesions on pathologic study were "active." In the operated and nonoperated eyes the vascular and nonvascular proliferative lesions were of equal severity. The sclerotomy wounds were complicated by intraocular granulation tissue, focal granulomatous inflammation related to suture fragments, and intraocular hemorrhage.     

Removal of silicone oil following diabetic vitrectomy.

The outcome of the removal of silicone oil from previously vitrectomised diabetic eyes was studied in a series of 25 eyes in 24 patients. Originally the patients presented with complex retinal detachments associated with proliferative diabetic retinopathy and all had reattached retinas after the initial operation. During the silicone tamponade, a number of complications had occurred. Cataract had developed in 14 eyes, glaucoma in eight, and reproliferation of fibrous membranes in 12. After the removal of silicone the retina redetached in three eyes (in all cases associated with severe postoperative haemorrhage), hypotony occurred in five eyes (transiently in four) and the seven eyes remaining phakic developed a cataract. In spite of these problems the eventual visual acuities returned to the immediate post-vitrectomy levels in almost all the eyes.     

Neovascular glaucoma following vitrectomy for diabetic eye disease

Between September 1979 and December 1985, 124 eyes of 105 patients underwent vitrectomy for diabetic eye disease. Until May 1987 (mean follow-up of 3.2 +/- 0.3 years) neovascular glaucoma (NVG) occurred in 21 eyes (17%); in 18 of them within the first post-operative year. Post-operative total retinal detachment (P = 0.0003) and pre- and/or per-operative aphakia (P = 0.0047) proved to be significant independent risk factors for post-operative NVG (odds ratio 9.9 and 4.6, respectively). The rate of NVG decreased from 22% in the second half of the study period (NS). This decrease may be related to smaller proportion of aphakic vitrectomies in the latter half (50% vs 18%, P less than 0.0004). Lack of previous panretinal photocoagulation did not increase the risk of NVG significantly. Of the 84 non-vitrectomized fellow-eyes NVG occurred in 17. In 4 of the 21 eyes the intraocular pressure (IOP) was satisfactorily controlled by antiglaucomatous medication after retinal panphotocoagulation, direct photocoagulation of the iris new vessels and/or cyclocryocoagulation. Four eyes remained hypertonic, but were comfortable with symptomatic medication, 12 eyes became hypotonic. One eye was enucleated. Useful vision was preserved in 3 eyes, light perception (LP) in 2 eyes, the remaining 16 lost LP. In 13 of the 16 eyes vision was lost within the first post-operative year.     

Light perception in diabetic vitreous haemorrhage and its prognostic value in pars plana vitrectomy

Ninety-two years with a pre-operative visual function of light perception 6 m or less, were treated with vitrectomy because of diabetic vitreous haemorrhage. The post-operative visual function after 6 months was improved to 5/50-5/5 in 37 eyes and counting fingers from 1 to 5 m in 32 eyes. In 23 eyes the postoperative visual function was unchanged or decreased, and among these were all 7 eyes with pre-operative light perception at 1.5 m or less. No eye with pre-operative light perception at 1.5 or less benefitted from vitrectomy due to extensive retinal damage.     

Intraoperative argon endophotocoagulation for recurrent vitreous hemorrhage after vitrectomy for diabetic retinopathy

We reviewed the medical records of 103 consecutive cases of vitrectomy performed for complications of diabetic retinopathy to determine if the introduction of argon laser endophotocoagulation had reduced the incidence of recurrent vitreous hemorrhage. Twenty-six eyes (48%) treated with endophotocoagulation and 35 (71%) eyes not receiving laser treatment had a recurrent hemorrhage. Follow-up was shorter for the eyes treated with endophotocoagulation, but a log-rank analysis to allow for this variable confirmed the benefit of laser photocoagulation (P less than .05). The proportion of eyes requiring surgical removal of the hemorrhage was also significantly lower in the group receiving endophotocoagulation (P less than .05). The beneficial effect of intraoperative laser treatment was independent of the amount of preoperative laser treatment, aphakia, and indications for the original vitrectomy surgery.     

Temporary silicone oil implantation following vitrectomy in proliferative diabetic retinopathy

Report on 23 patients with proliferative diabetic retinopathy who underwent silicone oil implantation due to recurrent intravitreal hemorrhages following pars plana vitrectomy. Postoperatively, it was possible to perform panretinal laser photocoagulation without difficulty or haste. After an average period of 4 months, silicone oil was removed from 10 eyes. Subsequent hemorrhages in 4 of these eyes are due to diabetic retinopathy, not to silicone oil. In 6 cases, silicone oil removal is planned for the near future; in a further 7 cases, silicone oil removal has been postponed because of the potential danger of further traction retinal detachment.     

Treatment of progressive or recurrent epithelial ingrowth with ethanol following laser in situ keratomileusis

PURPOSE: To evaluate the use of ethanol in the treatment of progressive or recurrent epithelial ingrowth following laser in situ keratomileusis (LASIK). METHODS: Four eyes of four patients with aggressive epithelial ingrowth following LASIK underwent epithelial ingrowth removal with 50% ethanol. Aggressive epithelial ingrowth was defined as, 1) progressive enlargement on serial examination with an area of ingrowth involving at least 30% of the flap surface area, 2) epithelial ingrowth associated with stromal melting as evidence on clinical or topographic examination, or 3) recurrent epithelial ingrowth in the same area following previous removal. RESULTS: Epithelial ingrowth was removed successfully in all eyes. No eye lost best spectacle-corrected visual acuity. One eye with multiple risk factors for failure experienced nonprogressive recurrence. No eyes required reoperation for recurrent epithelial ingrowth. No eyes experienced progression of stromal melt. Regularization of corneal topography was observed in an eye with preoperative stromal melting. The only complication was a tendency for the development of diffuse lamellar keratitis. Two eyes (50%) experienced diffuse lamellar keratitis following epithelial ingrowth removal with ethanol, which resolved completely with topical corticosteroids. CONCLUSION: Ethanol may be a useful adjunct in the treatment of aggressive or recurrent epithelial ingrowth following LASIK. Cautious use with the lowest concentration of ethanol may prove useful in these difficult epithelial ingrowth cases. Randomized and prospective studies are recommended to evaluate our experience.     

Flap suturing with proparacaine for recurrent epithelial ingrowth following laser in situ keratomileusis surgery

PURPOSE: To evaluate the safety and efficacy of flap suturing with proparacaine application for the management of recurrent epithelial ingrowth following laser in situ keratomileusis (LASIK). SETTING: Private consultation practice and Department of Ophthalmology, Rush University, Chicago, Illinois, USA. METHODS: Six eyes of 5 patients with recurrent epithelial ingrowth had flap lifting followed by debridement of interface epithelial cells, interface application of proparacaine, and the placement of interrupted 10-0 nylon sutures. RESULTS: Four eyes achieved a best corrected visual acuity (BCVA) of 20/40 or better. Two eyes required repeat debridement with suturing and were stable with at least a 1-year follow-up. No eye lost more than 1 line of BCVA. Three eyes regained excellent uncorrected visual acuity due to a reduction in induced astigmatism. CONCLUSIONS: Recurrent epithelial ingrowth following LASIK surgery can be a visually debilitating condition. Flap suturing with interface proparacaine application may be effective in preventing further recurrences of epithelial ingrowth after initial debridement.     

增生性糖尿病视网膜病变再次玻璃体手术的原因及预后分析

目的 探讨增生性糖尿病视网膜病变再次手术的原因和治疗预后.设计回顾性、非对照病例研究.研究对象242例因增生性糖尿病视网膜病变行玻璃体手术的患者.方法 回顾性总结2002～2006年因增生性糖尿病视网膜病变接受玻璃体切割术治疗的住院病例,对其中行再次手术病例的原因、出现并发症的时间、再次手术后视力等进行分析.主要指标再次手术原因、视力.结果 在入选的242例患者288眼中,32眼接受再次手术,其中24眼再次行玻璃体手术,8眼行巩膜扣带等其他手术治疗.24眼再次行玻璃体手术的原因分别为视网膜脱离13眼(54.2%),玻璃体再出血9眼(37.5%),视网膜脱离合并玻璃体出血1眼(4.2%),黄斑前膜1眼(4.2%).再次玻璃体手术后视力改善者4眼.基本不变者14眼,下降者6眼.再次与一次玻璃体手术后光感/无光感的发生率经χ2检验,差异有统计学意义(P=0.003).结论 增生性糖尿病视网膜病变再次玻璃体手术的原因主要为视网膜脱离和玻璃体再出血,再次手术后光感,无光感的发生率较高,应重在预防.(眼科,20D8,17:235-238)