ABSTRACT
Objective To analyze the etiologies of severe vitreous hemorrhage in venerable age patients.Methods A retrospective series case study was adopted.Medical records of 30 cases 30 eyes severe vitreous hemorrhage venerable age patients were analyzed in Xuanwu Hospital Capital Medical University,Peking University Third Hospital and Beijing Tsinghua Chang Gung Hospital from July in 1999 to June in 2015.Visual acuity,intraocular pressure,anterior segment slit lamp microscopy,mydriasis funduscopy and ophthalmic B type ultrasound examination were used to evaluate 30 cases 30 eyes.Thirty eyes were all treated with pars plans vitrectomy (PPV).Results Mydriasis funduscopy examination showed that vitreous hemorrhage was so dense in 30 eyes that the fundus cannot be observed.The initial visual acuity examination showed that 8 eyes were count finger,5 eyes were hand move,16 eyes were light perception,and 1 eye was no light perception.There were dense light spots or clusters of high echoes in vitreous cavities,complete/incomplete posterior vitreous detachment (PVD) of all eyes;retinal detachment with different degrees in 5 eyes;proliferating cord adhesion to the wall of eyeball in 3 eyes.The etiologies included retinal vein occlusion (RVO) in 10 eyes (33.33％),retinal tear or retinal detachment in 7 eyes (23.33％),polypoidal choroidal vasculopathy (PCV) in 7 eyes (23.33％),proliferative diabetic retinopathy (PDR) in 4 eyes (13.33％).The above 4 etiologies were in 28 eyes,accounting for 93.33％.The others were ocular trauma in 2 eyes (6.67％).Conclusions The main cause to severe vitreous hemorrhage venerable age patients is RVO,followed by retinal tear or retinal detachment,PCV and PDR.Ocular trauma is rare.Vitrectomy is a diagnostic treatment,which can remove vitreous hemorrhage,improve the visual acuity of the patients,and determine the etiologies of the vitreous hemorrhage.
ABSTRACT
Background Vitrectomy is an effective method to proliferative diabetic retinopathy (PDR) in type 2 diabetic patients.Postoperative vitreous hemorrhage is a major cause of vision loss.Objective This study was to analyze the related factors of vitreous hemorrhage after vitrectomy in proliferative retinopathy with type 2 diabetes.Methods Three hundred and five eyes of 305 cases who received vitrectomy for PDR from type 2 diabetes were retrospectively investigated.The clinical data of 14 eyes with vitreous hemorrhage after vitrectomy were analyzed.Results Vitreous hemorrhage after vitrectomy occurred in 14 eyes with the incidence 4.6％.The PDR was grade ⅣV in 3 eyes,grade Ⅴ in 4 eyes and grade Ⅵ in 7 eyes.Pars plana vitrectomy with intraocular laser photocoagulation was performed on all the 14 eyes,and 1 eye accepted scleral condensation and 8 eyes accepted silicone oil tamponade.Visual acuity was improved in 6 eyes,unchanged in 4 eyes and worsen in 4 eyes after initial surgery.Vitreous hemorrhage appeared in postoperative 1-7 days in 9 eyes,8 days-3 months in 1 eye,3-6 months in 2 eyes and over 6 months in 2 eyes.The cause for postoperative vitreous hemorrhage included residual neovascular membrane,insufficient photocoagulation range and intensity,neovascularization and instable blood glucose level.Vitreous hemorrhage disappeared in 5 eyes after medicine therapy,and reoperation in 9 eyes.In the end of the follow up,visual acuity improved in 9 eyes,unchanged in 2 eyes and worsen in 3 eyes.Retinas reattached in 13 eyes.However,the retina was still detached in 1 eye with silicone oil tamponade.Conclusions Postoperative vitreous hemorrhage usually occurs within 1 week.The main related factors are residual retinal neovascular membrane,inadequate intraocular laser photocoagulation and unstable blood glucose level.Medicine therapy is effective for postoperative vitreous hemorrhage in type 2 diabetic patients,but re-vitrectomy is needed for excessive vitreous bleeding.