Rhegmatogenous retinal detachment associated with massive spontaneous suprachoroidal hemorrhage and prognosis of pars plana vitrectomy

AIM:To describe the clinical characters of rhegmatogenous retinal detachment(RRD) associated with massive spontaneous suprachoroidal hemorrhage(SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy.METHODS:A retrospective review of 6 cases(6 eyes)of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage,phacoemulsification(PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported.RESULTS:In the 6 affected eyes of 6 patients(3 men and 3 women; mean age, 53.83y; range 34-61y),preoperative visual acuity ranged from faint light perception(LP) to counting finger(CF). The average interventional duration from visual decreased to surgery was 12.8 d(range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm(range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes.Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo(Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5eyes(83.33%) and no change in 1 eye(16.67%). Ocular hypertension ocurred in 1 eye(16.67%), which wassuccessfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy(PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively.CONCLUSION:RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.

Combined hamartoma of the retina and retinal pigment epithelium:A case report

BACKGROUND Combined hamartoma of the retina and retinal pigment epithelium(CHRRPE)is a rare congenital benign tumor which is commonly monocular.Typical CHRRPE comprises slightly raised lesions at the posterior pole,with proliferation membrane often leading to vascular distortion.In severe cases,macular edema,macular hole,retinal detachment or vitreous hemorrhage may occur.Patients with atypical clinical manifestations are prone to misdiagnosis by inexperienced ophthalmologists.CASE SUMMARY A 33-year-old man reported onset of right eye blurred vision for one week prior.Anterior segment and intraocular pressure were normal in both eyes.Left eye fundus photography was normal.Right eye ophthalmoscopy showed vitreous hemorrhage and off-white raised retinal lesions below the optic disc.Proliferative membranes on the lesion surfaces resulted in superficial retinal detachment and tortuosity and occlusion of peripheral blood vessels.A horseshoe-like tear in the temporal periphery was surrounded by retinal detachment.Optical coherence tomography revealed retinal thickening at the focal site with structural disturbance indicated by high reflectance.Right eye ultrasound showed retinal thickening at the lesion,stretching and uplifting of the proliferative membrane,with moderately patchy echo at the optic disc edge.Cytokines and antibodies were detected in vitreous fluids during the operation to rule out other diseases.Fundus fluorescein angiography(FFA)at postoperative follow-up led to final diagnosis of CHRRPE.CONCLUSION FFA is helpful in diagnosing retinal and retinal pigment epithelial combined hamartoma.In addition,other cytokine and etiological tests facilitate further differential diagnosis to rule out other suspected diseases.

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.·

Retinal hemorrhage as a unique ophthalmic manifestation of cerebral hyper perfusion syndrome

Cerebral hyperperfusion syndrome (CHPS) is a rare disease with complications of carotid artery revascularization. Acute retinal hemorrhage is a very rare entity that has been previously described as a manifestation of CHPS followed by the carotid artery stenting (CAS), but to the best of our knowledge, not yet described as a complication of carotid surgery. An Ascending Aorta to bilateral Carotid bypass was performed in a 35 years old woman with active Takayasu arteritis and 95% symptomatic stenosis of both common carotid arteries. Severe retinal hemorrhage appeared on the second post operative day combined with high blood pressure, brain edema on CT scan and grand mal seizures. It seems that fundoscopic examination followed by the carotid revascularization of tightness can be helpful in identifying those patients who develop symptoms suggesting of CHPS.

Retinal hemorrhage as a unique ophthalmic manifestation of cerebral hyper perfusion syndrome

Cerebral hyperperfusion syndrome (CHPS) is a rare, complication of carotid artery revascularization. Acute retinal hemorrhage is a very rare entity previously described as a manifestation of CHPS following carotid artery stenting (CAS), but to the best of our knowledge, not yet described as a complication of carotid surgery. An Ascending Aorta to bilateral Carotid bypass was performed in a 35-year-old woman with active Takayasu arteritis and 95% symptomatic stenosis of both common carotid arteries. Severe retinal hemorrhage appeared on the second post operative day combined with high blood pressure, brain edema on CT scan and grand mal seizures. It seems that fundoscopic examination following carotid revascularization of tight can be helpful in identifying those patients who develop symptoms suggesting of CHPS.

TCM Treatment of Fundus Hemorrhage due to Obstruction of Retinal Vein

Twenty-four cases (25 eyes) of fundus hemorrhage due to obstruction of the retinal vein were treated with traditional Chinese herbal drugs and satisfactory therapeutic results were obtained. A brief report is as follows.……

Sickle cell retinopathy and systemic disease

Sickle cell disease(SCD)is a widespread hemoglobinopathy that results in significant patient morbidity and mortality.Vascular occlusion can cause acute pain,acute chest syndrome,and avascular necrosis,while hemolysis and endothelial disruption can cause ischemic stroke,leg ulcers,pulmonary hypertension,and priapism.All ocular and orbital structures can be affected by SCD ischemic events,including orbital bone infarction,ischemic optic neuropathy,retinal artery occlusion,hyphema,secondary glaucoma,sickle cell maculopathy,and sickle cell retinopathy.Proliferative sickle cell retinopathy(PSR)is the most common cause of vision loss.Untreated PSR can lead to macular ischemia,vitreous hemorrhage,and tractional retinal detachment.Ophthalmic screening exams and multimodal imaging can lead to earlier detection of sickle cell retinopathy and improved patient outcomes.SCD patients undergoing vitreoretinal surgery may require coordination of care with hematologists to avoid ischemic complications.While hydroxyurea was the only United States Food and Drug Administration approved treatment for several decades,patients with SCD now have several more treatment options.Despite the United States screening all infants for SCD,there can be delays in diagnosis and treatment.This review article aims to provide an overview of sickle disease for the ophthalmologist,and to discuss emerging treatment options and current management of SCD ocular complications.

Comment on “Ultrasound reliability in detection of retinal tear in acute symptomatic posterior vitreous detachment with vitreous hemorrhage”

Dear Editor,We were interested to read the paper by Kuzmanovic Elabjer et al.The purpose of the authors was to assess ultrasound reliability in detecting retinal tears in patients with acute symptomatic posterior vitreous detachment （ASPVD）. They performed transpalpebral ultrasound of the eye and the orbit followed by fundus examination initially and in 6wk period.

Is there a relationship between dopamine and rhegmatogenous retinal detachment?

Dopamine and its receptors have been widely studied in the neurological conditions and in the retina. In this study, we evaluated the possible role of dopamine in rhegmatogenous retinal detachment(RRD) by comparing the amount of 3,4-dihydroxyphenylacetic acid(DOPAC), a surrogate index of retinal dopamin levels, in the vitreous sample of patients affected by RRD with those affected by macular pucker and vitre ous hemorrhage. Our results showed that significantly higher levels of DOPAC were found in the vitreou sample of patients affected by RRD compared with those affected by vitreous hemorrhage and macula pucker(P = 0.002). Specifically, no trace of the substance was found in vitreous hemorrhage and macula pucker samples. A slightly significant positive correlation was found among DOPAC and post-operativ best corrected visual acuity(r = 0.470, P = 0.049). No correlation was found between DOPAC and the day elapsed between diagnosis and surgery(P = 0.317). For the first time our findings suggest that DOPAC i released in RRD, but not in other retinal diseases such as vitreous hemorrhage and macular pucker. More over, we showed a correlation between visual acuity outcome and the amount of DOPAC in the vitreous This might have a potential, although still unknown, implication in the pathogenesis of the disease and/o in the associated photoreceptors loss. This study was approved by the Ethics Committee of Rome Tor Ver gata University Hospital(R.S.92.10) on September 24, 2010.

Hemorrhagic Valsalva Retinopathy in a Pregnant Woman

Valsalva retinopathy is caused by a sudden increase in intra-thoracic or abdominal pressure, following forced expiration, with mouth and nose closed (Valsalva maneuver). We report a case of Valsalva retinopathy in a pregnant woman. A 36 years old patient, pregnant at 24 weeks of amenorrhea, who consulted for sudden visual acuity decrease of the left eye, evolving since 24 hours after Valsalva maneuvers to calm down her panic and control her breathing. The refraction has demonstrated a decrease of visual acuity in the left eye to “can see a hand moving”, while the visual acuity remained normal in the right eye. Spontaneous evolution was marked by a fast and progressive reduction of hemorrhage and progressive recovery of vision in the left eye. Valsava retinopathy was first described in 1972 by Thomas Duane. Physical activity is usually found before it occurs. Many situations are usually associated to this occurrence among which: pregnancy, vomiting, weightlifting or trauma. Regression of this hemorrhage without sequelae is usual. But sometimes, we need a Nd:Yag laser treatment or surgery to evacuate the blood.

Ratio of Primary Episcleral Buckling Surgery versus Primary Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To assess the ratio of the frequency of primary scleral buckling procedures versus the frequency of vitrectomies performed as treatment for rhegmatogenous retinal detachments in a primary retinal surgical department.Methods: The study included all patients with rhegmatogenous retinal detachments who underwent retinal or vitreoretinal surgery in the study period from 2002 to 2006. The size of the retinal defect and the amount of proliferative vitreoretinopathy were not exclusion criteria. Patients with tractional retinal detachment due to proliferative ischemic retinopathies were excluded.Results: In the study period, 875 primary retinal and vitreoretinal surgeries were performed on 875 eyes. Among the surgeries, episcleral sponges(42.9%) formed the largest part,followed by pars plana vitrectomies(35.0%) and encircling bands(22.2%). Combining episcleral sponges and encircling bands into an episcleral surgery group revealed that two thirds(65%).of the surgeries were episcleral interventions. In the episcleral sponge group, the retinal re-detachment rate after the first surgery was 13%.Conclusion: In a university department as a primary referral unit for retinal detachments, episcleral retinal surgery can still outnumber vitreoretinal interventions, with retinal re-detachment rates which do not differ markedly from the re-detachment rates reported in randomized trials comparing vitreoretinal surgery with episcleral surgery.

Exudative Retinal Detachment Associated with Complicated Retrobulbar Anesthesia

Retrobulbar anesthesia (block) is used for many ocular surgeries, whereas it is well known that this procedure has complications such as for retrobulbar hemorrhage, globe perforation, optic nerve injury and brain stem anesthesia. In this report, we present a unique case in the literature of isolated exudative retinal detachment (RD) secondary to iatrogenic retrobulbar hemorrhage. A 73-year-old woman underwent retrobulbar block for combined phaco-vitrectomy. Immediately after the injection, progressive proptosis was recognized. The globe was decompressed and she underwent combined phaco-vitrectomy after stabilization of the eye on the same day. At the be-ginning of the vitrectomy, a dome shaped serous RD was observed in the infero-temporal quadrant. Peripheral exploration was performed, whereas there was no retinal tear or hole. On the first day postoperatively, serous RD was disappeared. In conclusion, this report suggests that increased intraorbital pressure secondary to iatrogenic retrobulbar hemorrhage might lead exudative RD.

养血滋阴方联合针刺治疗糖尿病眼底出血临床研究

目的:观察养血滋阴方联合针刺治疗糖尿病眼底出血的临床疗效及对动脉血流、视野的影响。方法:采用随机数字表法将124例糖尿病眼底出血患者分为对照组、观察组各62例。2组均给予常规西药治疗,对照组在常规西药治疗基础上联用针刺治疗,观察组在对照组基础上联用养血滋阴方治疗,2组连续治疗1个月。比较2组治疗前后眼动脉血流指标(舒张期血流速度峰值、收缩期血流速度峰值、阻力指数)、眼底出血面积、黄斑厚度、视野灰度值、血管瘤体积、视网膜电图振荡电位(OPs);比较2组治疗前后最佳矫正视力(BCVA)、视功能相关的生活质量量表(VFQ-25)、中医证候评分;比较2组治疗前后趋化因子样受体1(CMKLR1)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)、血小板源性生长因子-BB(PDGF-BB)水平,并评估2组临床疗效及不良反应发生情况。结果:观察组总有效率96.77%,高于对照组83.87%(P<0.05)。2组治疗后CMKLR1、TNF-α、VEGF、PDGF-BB水平及眼底出血面积、黄斑厚度、视野灰度值、血管瘤体积、阻力指数、OPs、VFQ-25、中医证候评分均较治疗前降低(P<0.05),观察组治疗后CMKLR1、TNF-α、VEGF、PDGF-BB水平及眼底出血面积、黄斑厚度、视野灰度值、血管瘤体积、阻力指数、OPs、VFQ-25、中医证候评分均低于对照组(P<0.05)。2组治疗后舒张期血流速度峰值、收缩期血流速度峰值、BCVA水平升高(P<0.05),观察组治疗后舒张期血流速度峰值、收缩期血流速度峰值、BCVA水平高于对照组(P<0.05)。结论:养血滋阴方联合针刺治疗糖尿病眼底出血疗效确切,能够抑制机体炎症,保护患者视网膜屏障,改善眼动脉血流、视力,提高生活质量。

2种喜树碱类拓扑异构酶1抑制剂ADE信号的挖掘与分析

目的对2种喜树碱类拓扑异构酶1抑制剂伊立替康和托泊替康的药物不良事件(ADE)信号进行挖掘与分析,为临床安全用药提供参考。方法基于美国FDA不良事件报告系统(FAERS)数据库,提取2004年1月1日至2023年3月31日上述2种药物的ADE报告数据。对数据进行处理后,采用报告比值比法联合贝叶斯置信传播神经网络法进行信号挖掘,并进行分析。结果共筛选出相关ADE报告14738份,其中伊立替康11483份,托泊替康3255份。伊立替康的ADE报告性别以男性为主,托泊替康以女性为主;两药的使用患者年龄均主要集中于45~<75岁。共检测出847个信号,累及24个系统器官分类(SOC)。其中,伊立替康检测出565个信号,累及24个SOC,主要集中于胃肠系统疾病、全身性疾病及给药部位各种反应、血液及淋巴系统疾病等;报告频数最多的ADE为腹泻,信号强度最大的ADE为胆碱能综合征。托泊替康检测出282个信号,累及22个SOC,主要集中于全身性疾病及给药部位各种反应、各类检查、血液及淋巴系统疾病、胃肠系统疾病等;报告频数较多的ADE为死亡和贫血,信号强度最大的ADE为发热性骨髓再生障碍。伊立替康的转移性结肠直肠癌、外周感觉神经病、脂肪性肝炎等ADE和托泊替康的虹膜萎缩、视网膜变性、玻璃体积血等ADE均未在各自说明书中提及。结论伊立替康和托泊替康的ADE主要累及消化系统和血液系统,临床上应重点监测;伊立替康所引起的胆碱能综合征应引起关注。除此之外,使用伊立替康的患者还应关注转移性结肠直肠癌、外周感觉神经病、脂肪性肝炎、蛋白尿等ADE,使用托泊替康的患者应加强眼器官疾病的监测,以确保用药安全。

脐血血管内皮生长因子水平及血气分析与新生儿视网膜出血相关性研究

目的:探讨脐血血管内皮生长因子(VEGF)水平及血气分析与新生儿视网膜出血(RH)的相关性。方法:选取产科分娩并且行新生儿眼底筛查的596例新生儿。统计新生儿眼底检查结果,根据是否伴有眼底出血分为RH组(230例)和正常对照组(366例),分析VEGF水平及血气分析与新生儿RH的关系。结果:596例新生儿中,RH发生率为38.59%(230/596)。两组患者在产妇年龄、产次、多胎、分娩方式、窒息、产钳助产、胎龄、VEGF、pH值、二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、碱剩余(BE)值比较,差异有统计学意义(均P<0.05);而在妊娠期糖尿病、妊娠期高血压、贫血、性别、出生体重比较,差异无统计学意义(均P>0.05)。阴道分娩、窒息、产钳助产、VEGF≥251.67pg/ml、pH值<7.32、PaCO_(2)≥52.53mmHg、PaO_(2)<24.37mmHg、BE值<-3.49mmol/L是影响新生儿RH的独立危险因素(均P<0.05)。结论:脐血VEGF水平及血气分析均与KH密切相关。

新生儿视网膜出血与脐动脉血气分析变化的相关性研究

目的探讨新生儿视网膜出血(RH)与脐动脉血气指标变化的关系。方法选取2018年5月至2021年12月期间在沧州市人民医院产科出生并行视网膜筛查的596例新生儿,根据新生儿是否视网膜出血分为出血组(n=230)和对照组(n=366),并依据出血程度可分为Ⅰ度组(n=95)、Ⅱ度组(n=75)和Ⅲ度组(n=60)。比较出血组与对照组及Ⅰ度、Ⅱ度、Ⅲ度组新生儿脐动脉血气指标氢离子浓度指数(pH)值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))及剩余碱(BE)值,并应用Logistic回归模型分析影响RH发生的相关因素,采用受试者工作特征曲线(ROC)分析脐动脉血气指标对RH的预测价值。结果出血组pH值、PaO_(2)及BE值明显低于对照组,PaCO_(2)则高于对照组(P<0.05)。随视网膜出血程度的增加pH值、PaO_(2)及BE值降低,PaCO_(2)水平则升高,差异有统计学意义(P<0.05)。出血组产妇妊娠期糖尿病、妊娠期高血压、阴道分娩、产钳助产、急产、早产儿及新生儿有窒息史占比高于对照组(P<0.05)。多因素Logistic回归分析模型显示,早产儿、产妇妊娠期高血压、产妇阴道分娩、新生儿有窒息史及脐动脉血气中高水平PaCO_(2)及低水平PaO_(2)、BE、pH值均是影响RH的危险因素(P<0.05)。ROC曲线分析显示,pH值、PaO_(2)、PaCO_(2)及BE预测RH发生的AUC分别为0.755、0.719、0.669、0.816,pH值和BE的预测效能高于PaO_(2)和PaCO_(2)(P<0.05)。结论新生儿脐动脉血气指标与RH发生、发展紧密相关,且对RH的筛查具有一定的参考价值,其中pH值和BE筛查价值较高。

玻璃体切除术在增殖期糖尿病视网膜病变中的应用进展

增殖期糖尿病视网膜病变(PDR)是糖尿病引起的一种复杂且危险的眼部并发症,常导致严重的视力受损。对于PDR患者,玻璃体切除术(PPV)是首选治疗方法,通过消除眼内新生血管(NV),纠正玻璃体积血(VH)和防止视网膜脱离(RD),从而维护患者的视觉功能和生活质量。近年来,随着微创玻璃体切割手术(MIVS)、广角观察系统(WAVS)、数字辅助可视化系统(DAS)、视网膜光凝术及抗血管内皮生长因子(VEGF)治疗等技术的不断发展和应用,PPV不仅明显改善PDR患者的视力,同时还能实现长期的解剖稳定性。因此,PPV成为糖尿病患者确切有效治疗的重要技术之一。本综述将对PDR中PPV的应用进行全面概述。

基于血水同治理论探讨渗出性老年性黄斑变性的治疗

渗出性老年性黄斑变性(wet age-related macular degeneration, w AMD)常见于老年人,病情呈进行性发展,对视力造成严重影响,降低患者生活质量。血水同治理论是基于血水同源互化、同病互害的生理病理特点,以活血利水法为基础,辨证施治,广泛应用于临床。根据w AMD的中医病机,可辨证分为肝肾阴虚、肝脾失衡及脏腑失调。本文基于血水同治理论,对w AMD进行分期论治,并对视网膜脱离、玻璃体积血等并发症辨证论治,在临床上疗效确切。

5307例新生儿眼底筛查结果及眼底疾病相关因素分析

目的:探讨5 307例新生儿眼底筛查结果及眼底疾病的相关因素。方法:选取2022-01/12在我院眼科进行眼底筛查的新生儿5 307例,采用RetCamⅢ系统进行眼底检查,记录眼底异常情况,分析足月儿发生视网膜出血和早产儿发生早产儿视网膜病变(ROP)的影响因素。结果:纳入新生儿眼部异常发生率为27.17%,其中视网膜出血发生率最高(61.23%),其次为视网膜渗出(22.95%)、ROP和ROP样视网膜病变(10.68%),牵牛花综合征(0.21%)、白化病性眼底(0.21%)和永存胚胎血管(PFV)(0.28%)发生率较低。足月儿眼部异常发生率低于早产儿(26.30%vs 30.08%,P<0.05),足月儿视网膜出血、视网膜渗出发生率均高于早产儿(P<0.05),早产儿ROP和ROP样视网膜病变发生率高于足月儿(P<0.05)。顺产是足月儿发生视网膜出血的危险因素(P<0.05)。胎龄(32-34、30-31周)、出生体质量(1 500-2 499、<1 500 g)、奶粉喂养、吸氧是早产儿发生ROP的危险因素(均P<0.05)。结论:本院新生儿眼部异常发生率较高,通过眼底筛查可及早发现新生儿眼部异常。

基于灰度幅值直方图的视网膜出血点检测算法

为减少图像亮暗不均、出血点间灰度差异大对视网膜出血点检测结果的影响,提出一种基于灰度幅值直方图零点阈值与区域特征分析的视网膜出血点检测算法。算法通过大尺度中值滤波器实现图像的阴影校正,结合凹凸线段对背景干扰点进行抑制,完成前期的预处理操作;由各行各列幅值直方图中第一个零点进行暗目标自动阈值分割,并基于幅值特征的区域生长改善血管连续性;根据血管与出血点间形状的不同去除血管,实现了出血点分割。在DIARETDB1公开图库中的测试结果验证了算法的有效性。