Vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis

·AIM:To describe a case in which vitrectomy was required for vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis (LCVA) for non-ischemic central retinal vein occlusion (CRVO).·METHODS:Observational case report.·RESULTS:A 72-year-old man complained of central scotoma in the left eye,and was diagnosed as suffering from non-ischemic CRVO.LCVA was performed in another hospital.Although favorable visual function was briefly maintained postoperatively,severe vitreous hemorrhage developed in his left eye,necessitating vitrectomy.·CONCLUSION:Considering that LCVA carries a risk of serious complications,we must apply this treatment with caution,especially in ethnic groups,such as the Japanese,in whom pigmentation reacts to photocoagulation excessively.·

Fibrovascular proliferation of retinopathy of prematurity in zone Ⅱ after initial ranibizumab treatment

This study was designed to explore the prevalence of fibrovascular proliferation not regressed in zone Ⅱ stage 3 retinopathy of prematurity(ROP)after initial intravitreal ranibizumab(IVR)injections and to explore the possible influence factors.Fifty-seven patients(108 eyes)with ROP who underwent intravitreal injection of ranibizumab between January 2013 and July 2014 participated in the retrospective study.Based on regress of fibrovascular tissue or not after initial injections of ranibizumab,eligible eyes were divided into two groups.Data was collected and analyzed with SPSS 16.0.In the study,108 eyes of 57 patients(18 females,39 males)underwent initial intravitreal injection.The mean birth weight was 1,440.0±357.7 g and the mean gestational age was 30.5±2.0 weeks.Eight of 57(14.0%)patients showed unfavorable fibrovascular proliferation after initial ranibizumab treatment within 2 weeks.Among them,11 eyes were controlled by further laser treatment and 3 eyes underwent vitrectomy.The difference of occurrence rate in hemorrhage between the two groups was significant(P<0.030),and the unfavorable group required more laser treatment(P<0.001).The incidence of unfavorable fibrovascular proliferation was relatively high,and intraocular hemorrhage was possibly associated with the progress in zone Ⅱ stage 3 ROP after initial IVR injection.

The role of heredity in pterygium development

Several risk factors,which include heredity,ultra-violet (UV) light and chronic inflammation,contribute to pterygium development.However,there is no report integrating these factors in the pathogenesis of pterygium.The aim of this review is to describe the connection between heredity,UV,and inflammation in pterygium development.Existing reports indicate that sunlight exposure is the main factor in pterygium occurrence by inducing growth factor production or chronic inflammation or DNA damage.Heredity may be a factor.Our studies on factors in pterygium occurrence and recurrence identify that heredity is crucial for pterygium to develop,and that sunlight is only a trigger,and that chronic inflammation promotes pterygium enlargement.We propose that genetic factors may interfere with the control of fibrovascular proliferation while UV light or(sunlight)most likely only triggers pterygium development by inducing growth factors which promote vibrant fibrovascular proliferation in predisposed individuals.It also just triggers inflammation and collagenolysis,which may be promoters of the enlargement of the fibrovascular mass.Pterygium probably occurs in the presence of exuberant collagen production and profuse neovascularisation.

Newly diagnosed diabetes mellitus patients presenting with proliferative diabetic retinopathy as an initial sign

AIM: To investigate the clinical features of newly diagnosed diabetes mellitus(NDM) patients showing proliferative diabetic retinopathy(PDR) as an initial sign. ·METHODS: As a retrospective case series,the medical records of a total of four hundred and thirty-two patients who underwent a vitrectomy due to PDR were reviewed to find the subjects. Of 432 patients,six cases of NDM patients showing PDR as an initial sign were included and analyzed with their systemic and ocular features. Main outcome measures: the systemic features and ocular features [preoperative and postoperative best corrected visual acuity(BCVA),intraoperative findings]. ·RESULTS: The mean onset age of visual symptoms was 36.3 years old. The mean serum insulin and C-peptide titer was below the normal range. The mean fasting plasma glucose was 178mg/dL and the mean postprandial 2h plasma glucose was 306mg/dL. The mean HbA1c at diagnosis was 11.02%. In all cases,an acute progressive fibrovascular proliferation was observed. Intraoperative retinal tears were found in three cases of six. The mean preoperative BCVA was +0.67 ± 0.58 logMAR and the mean BCVA at postoperative 6 months was +0.20±0.30 logMAR. ·CONCLUSION: All patients were considered to have latent autoimmune diabetes in adults(LADA). A rapid deterioration of kidney function as well as poor diabetic control status at diagnosis was observed in all six cases. The ocular features of the patients showed acute progressive fibrovascular proliferation and relatively favorable postoperative visual acuity.

Update on indications for diabetic vitrectomy and management of complications

Despite appropriate management of the systemic disease,patients with diabetes may develop severe forms of diabetic retinopathy that require surgery.Non-clearing vitreous haemorrhage(VH),traction retinal detachment involving the macula,combined traction and rhegmatogenous retinal detachment,progressive fibrovascular proliferation(PFP)and rubeosis with acute VH represent the main indications for surgery.Vitrectomy techniques and surgical tools have developed dramatically in the last decade in order to help the surgeon succeed in these challenging cases.